2025 Halifax EE Benefits : simplebooklet.com

Cafeteria Plan Information 2025 Eligibility: Full-time employees working 30 hours or more per week. Benefit Plan Year and Enrolling for Benefits: •Benefit plan year is January 1, 2025 through December 31, 2025.•Benefits offered are only available to employees during open enrollment.•Deductions will begin with your pay period in January 2025.•Must be an active employee (not on disability or FMLA)•New hires will have 31 days following the date of hire, to enroll for benefits.Benefit Counselor Enrollment Meeting Face-to-Face enrollment Your 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 and 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. Insurance certificates are 40 pages or more 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. Certificate and/or Policy Information Coverage provided by the various voluntary supplemental benefits may have limitations and exclusions. Please refer to the 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. Please contact your tax advisor or benefit counselor if you have questions. Plans offered in this Employee Benefit Guide. Coverage provided by the various voluntary supplemental benefits contained herein are available through NBC Benefits, Inc. If you have a question or need information, please reach out to NBC. Contact information is included on the back page of this booklet. IMPORTANT NOTE & DISCLAIMER This is neither an insurance contract nor a Summary Plan Description; actual policy provisions apply. Information in this booklet, including premiums quoted, is subject to change. Policy descriptions are for information purposes only. Your actual policies may be different from the policies described in this booklet. Page 3

Page 4

Page 5

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. Nearly 3 million emergency department visits every year are caused by youth sports.1 For Halifax County Public Schools Employees COVERAGE 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 benefit 5 0% of burn benefit 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 5

Page 6

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) :4 COVERAGE 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 6

Page 7

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. Policies underwritten by the underwriting company listed above detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued. This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy apply. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder. Benefits are subject to state availability. © 2020 The Hartford. The Hartford compensates both internal and external producers, as well as others, for the sale and service of our products. For additional information regarding Hartford’s compensation practices, please review our website http://thehartford.com/group-benefits-producer-compensation. Accident Form Series includes GBD-2000, GBD-2300, or state equivalent. 5962g NS 08/21 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 of loss 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 or on behalf of the policyholder, or any employer or organization whose eligible persons are covered under the policy; or being used for tests, experimental purposes, 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. 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. Policies underwritten by the underwriting company listed above detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued. This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy apply. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder. Benefits are subject to state availability. © 2020 The Hartford. ACCIDENT BHS_ ACTIVE FULL-TIME EMPLOYEE 0 01651 26 Page 7

Page 8

A 10831MJBC ecnarusnI recna P sesaesid deificeps 92 dna recnac fo tnemtaert eht rof noitcetorH skroW tI woH s’ere• stnedneped ruoy edulcni nac egarevoC• 92 dna recnac rof egarevoc sedulcnIs sesaesid deificep• nehw syad 09 retfa muimerp fo reviaWd )ylno eeyolpme( recnac ot eud delbasi• ruoy ot refer ;deunitnoc eb yam egarevoCc sliated rof etacifitre• rof thgir s’taht egarevoc eht tceleSy ylimaf ruoy dna uo• a ro recnac htiw desongaid fIs mialc a elif uoy ,esaesid deificep• hsac mus-pmul a eviecer yam uoYb detisoped tcerid ro kcehc aiv tifenet hsiw uoy revewoh esu nac uoy tahY – sgnivas ruoy rof drah dekrow ev’uo d .tuo meht epiw sisongaid recnac a tel t'no• sgnivas dna gnikcehc ruoy tcetorP• )k(104 ro ASH ruoy otni pid t’noDP secnaniF ruoY gnitcetorM sdeeN ruoY gniteeT recnac evitaler raey-evif eh s revo devorpmi sah etar lavivru t rof sedaced lareves tsap eh m sepyt recnac tso† T srovivrus recnac fo rebmun eh i si dna ,gnisaercni si .S.U eht n e 1.22 ylraen ot pmuj ot detcepx m 0302 yb noilli††E devorpmi ,noitceted ylra t ot ssecca dna stnemtaer c taht srotcaf era era i lavivrus recnac ecneulfn† T SIHT TUOBA KNIHA secnanif ruoY .snoisiced tluciffid dna stnemtnioppa rotcod fo dniwlrihw a emoceb nac efil ruoy ,sisongaid recnac a retf d .reisae elttil a tser uoy pleh nac stifeneB etatsllA morf ecnarusnI recnaC .seirrow fo tsil ruoy ot dedda eb ot deen t’no †Life After Cancer: Survivorship by the Numbers, American Cancer Society, 2021. ††Cancer Treatment & Survivorship Facts & Figures, 2019-2021. GVCP3BVA Page 8

Page 9

G 3PCV BVA A 10831MJBT 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 sih rof yap pleh na f ,sesnepxe gnivil s’ylima s ,yticirtcele ,sllib sa hcu a sag dnF secnaniC ,sASH tcetorp pleh na s tnemeriter ,sgniva p morf s)k(104 dna snal b detelped gnieC ESOOHU EST .tnemllornE nepO s’reyolpme sih gnirud ecnarusnI recnaC stﬁeneB etatsllA rof pu sngis JT ,latrop bew tneinevnoc eht hguorht egarevoc ecnarusnI recnaC stifeneB etatsllA sih no mialc a selif J M .*stifeneByH :rof stifeneb hsac seviecer eC MIAL• tifeneB ssenlleW• sisongaiD laitinI recnaC• tnemenifnoC latipsoH suounitnoC• noitatropsnarT lacoL-noN• yregruS• aisehtsenA• gnigamI lacideM• enicideM dna sgurD tneitapnI• ecnadnettA s’naicisyhP• aesuaN-itnAR yrevoceP yregruS-tsoS yregruP gnitseT pO-er H yatS latipsoA eh ,yregrus retf s sruoh lareves sdnep i yrevocer eht n w moor gnitiaH sih ot derrefsnart s’e r yb detisiv dna moo h -2 a gnirud rotcod sid yats latipsoh yaT rotcod sih stisiv J r 2 a gnirud ylraluge m doirep yrevocer htnoH eht ot dettimda si e h rof latipso l etatsorp cipocsorapa c yregrus recnaT ASP seogrednu J t latipsoh a ta gnitse 3 morf selim 00 h emoh siM JT teeO tuoba noitamrofni tnatropmi ot ssecca 7/42 sreff y smialc ruoy kcehc dna timbus ,ngiSe .stifeneb ruo ( eb ot stifeneb hsac tseuqer ,)yrotsih mialc gnidulcnid lanosrep ot segnahc ekam ,detisoped tceri i .erom dna ,noitamrofn* latroP gniliF mialC stifeneByMA moc.etatslla.stifenebym :sseccA :htap tnemtaert sih s’ereH .recnac etatsorp sah eh taht snrael JT ,retal shtnom wef H stifeneb hsac sih esu nac JT syaw eht fo emos era ereT .yrav yam ecneirepxe laudividni ruoy ;noitautis lanoitcif a sliated evoba elpmaxe ehF .4 dna 3 segap ees ,stnuoma tifeneb dna stifeneb fo gnitsil a roPage 9

Page 10

ABJ30590-3 - Insert - 27778This material is valid as long as information remains current, but in no event later than August 9, 2027. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation. ©2024 Allstate Insurance Company. www.allstate.com or allstatebenefits.com.For use in enrollments sitused in: VA. This rate insert is part of the approved brochure for and is not to be used on its own.Cancer Insurance (GVCP3)Includes coverage for 29 Specified Diseases from Allstate BenefitsBENEFIT AMOUNTSHOSPITAL CONFINEMENT AND RELATED BENEFITSPLAN 1 PLAN 2Continuous Hospital Confinement (daily)$100 $300Government or Charity Hospital (daily)$100 $300Private Duty Nursing Services (daily)$100 $300Extended Care Facility (daily)$100 $300At Home Nursing (daily)$100 $300Hospice Care Center (daily) or$100 $300Hospice Care Team (per visit)$100 $300RADIATION/CHEMOTHERAPY/RELATED BENEFITSPLAN 1 PLAN 2Radiation/Chemotherapy for Cancer1 (every 12 months) $5,000 $12,500Blood, Plasma, and Platelets1 (every 12 months) $5,000 $12,500Hematological Drugs1 (every 12 months) $100 $250Medical Imaging1 (every 12 months) $250 $625SURGERY AND RELATED BENEFITSPLAN 1 PLAN 2Surgery2$1,500 $3,000Anesthesia (% of surgery benefit)25% 25%Bone Marrow or Stem Cell Transplant (once/year)1. Autologous$500 $1,0002. Non-autologous (cancer or specified disease treatment)$1,250 $2,5003. Non-autologous (Leukemia)$2,500 $5,000Ambulatory Surgical Center (daily)$250 $500Second Opinion$200 $400MISCELLANEOUS BENEFITSPLAN 1 PLAN 2Inpatient Drugs and Medicine (daily)$25 $25Physician’s Attendance (daily)$50 $50Ambulance (per confinement)$100 $100Non-Local Transportation1(coach fare or amount shown per mile*)0.40/Mile 0.40/MileOutpatient Lodging (daily; limit $2,000/12 mo. period)$50 $50Family Member Lodging (daily per trip; max. 60 days)$50 $50and Transportation (coach fare or amount shown per mile**)0.40/Mile 0.40/MilePhysical or Speech Therapy (daily)$50 $50New or Experimental Treatment3 (every 12 months) $5,000 $5,000Prosthesis3 (per amputation) $2,000 $2,000Hair Prosthesis (every 2 years)$25 $25Nonsurgical External Breast Prosthesis1$50 $50Anti-Nausea Benefit1 (once per calendar year) $200 $200Waiver of Premium (employee only)Yes YesOPTIONAL/ADDITIONAL BENEFITSPLAN 1 PLAN 2Cancer Initial Diagnosis (one-time benefit)$5,000 $5,000Wellness Benefit$100 $100PSA Testing/Digital Rectal Examinations$100 $1001Pays actual cost up to amount listed. 2Pays actual charges up to amount listed in certificate Schedule of Surgical Procedures. Amount paid depends on surgery. 3Pays actual charges up to amount listed. *At least 70 miles away, up to 700 miles. **Transportation up to 700 miles per continuous hospital confinement.PLAN 1 PREMIUMSMODEEE EE + SP EE + CH FMonthly$17.48 $27.81 $24.20 $34.50 PLAN 2 PREMIUMSMODE EE EE + SP EE + CH FMonthly$30.30 $47.10 $42.73 $59.50 Issue ages: 18 and over if actively at work Opt 1-1Hosp; 2Rad; 1Surg; 1Misc; 5Init; 0ICU; 4Well; 0ProgOpt 2-3Hosp; 5Rad; 2Surg; 1Misc; 5Init; 0ICU; 4Well; 0ProgV.2024.07.31 FA Rate Insert Creation Date: 8/9/2024FOR HOME OFFICE USE ONLY - GVCP3EE=Employee; EE + SP = Employee + Spouse; EE + CH = Employee + Child(ren); F = FamilyG 3PCV BVA A 10831MJBPage 10

Page 11

H STIFENEB DETALER DNA TNEMENIFNOC LATIPSOC tnemenifnoC latipsoH suounitno - i tneitapn a tnemenifnoc dna noissimdG latipsoH ytirahC ro tnemnrevo - c tpecxe ,stifeneb rehto lla fo ueil ni stnemenifno W muimerP fo reviaP secivreS gnisruN ytuD etavir - f emit-llu n naicisyhp gnidnetta yb dezirohtua secivres gnisruE ytilicaF eraC dednetx - w a fo syad 41 nihti h fo syad fo rebmun eht ot pu elbayap ;yats latipso t yats latipsoh ehA gnisruN emoH t - p tsum erac gnisrun etavir b ;yats latipsoh derevoc a fo syad 41 nihtiw nige p suoiverp eht fo syad fo rebmun eht ot pu elbaya h yats latipsoH maeT ro retneC eraC ecipso - t ssenlli lanimre c yad rep tisiv eno ;emoh ta ro ytilicaf a ni eraR STIFENEB DETALER DNA YPAREHTOMEHC/NOITAIDAR recnaC rof yparehtomehC/noitaida - c yfidom ro yortsed ot stnemtaert derevo c eussit suorecnaB steletalP dna amsalP ,dool - t ,snoisufsnar a ,gnissecorp ,segrahc noitartsinimd p gnihctam ssorc ,tnemerucorH sgurD lacigolotame - b senil llec stsoo f nehw elbayap ;steletalp dna stnuoc llec der/etihw ro R diap si tifeneb recnaC rof yparehtomehC/noitaidaM gnigamI lacide - i pu-wollof ro sisongaid laitin e maxe gnigami derevoc no desab noitaulavS STIFENEB DETALER DNA YREGRUS yregru - b fo eludehcS etacifitreC no desa S enod seiregrus erom ro owT .serudecorP lacigru a yrtne ro noisicni eno hguorht emit emas eht t p noitarepo ehT .noitarepo eno deredisnoc era tnio w si tneitaptuO .diap eb lliw tifeneb tsegral eht hti p eludehcS eht ni detsil tnuoma eht fo %051 ta dia o rehto rof yap ton seoD .serudecorP lacigruS f s stifeneb rehto yb derevoc seiregruA aisehtsen - 2 rof tifeneb yregruS fo %5 a tsitehtsena na yb deviecer aisehtsenB tnalpsnarT lleC metS ro worraM eno - a fo tnemtaert rof suogolotua-non ,suogolotu c ,aimekueL naht rehto esaesid deificeps ro recna o aimekueL fo tnemtaert rof suogolotua-non rA retneC lacigruS yrotalubm - p fi ylno elbaya S diap si tifeneb yregruS noinipO dnoce - s noinipo dnoce f ni ton rotcod a yb tnemtaert ro yregrus ro p rotcod ruoy htiw ecitcarM STIFENEB SUOENALLECSII enicideM dna sgurD tneitapn - n to i eht rednu derevoc enicidem/sgurd gnidulcn R -itnA ro recnaC rof yparehtomehC/noitaidaN stifeneb aesuaP ecnadnettA s’naicisyh - o tneitapni en v naicisyhp eno yb tisiA ecnalubm - t latipsoh morf ro ot refsnar w ro ecivres desnecil a yb denifnoc ereh h ecnalubma denwo-latipsoN noitatropsnarT lacoL-no - o gniniatb t yllacol elbaliava ton tnemtaerO gnigdoL tneitaptu -m selim 001 naht erof emoh morF noitatropsnarT dna gnigdoL rebmeM ylima - a lacol-non gnirud uoy htiw slevart rebmem ylimaf tlud h noitatropsnarT .tnemtaert dezilaiceps rof syats latipso n diap si tifeneb noitatropsnarT lacoL-noN fi diap toP yparehT hceepS ro lacisyh - t erotser o n noitcnuf ydob lamroN tnemtaerT latnemirepxE ro we - p elbaya i rof ylno dna yrassecen eb ot segduj naicisyhp f t stifeneb ycilop rehto rednu derevoc ton tnemtaerP sisehtsor - s citehtsorp fo noitatnalpmi lacigru d noitatupma hcae rof eciveH sisehtsorP ria - w owt yreve eceipriah ro gi y ssol riah ot eud sraeN sisehtsorP tsaerB lanretxE lacigrusno - i laitrap ro derevoc a retfa sisehtsorp laitin m ymotcetsaA tifeneB aesuaN-itn - p aesuan-itna debircser m sisab tneitaptuo no noitacideW )ylno eeyolpme( muimerP fo revia - m tsu b gnol sa ,recnac ot eud wor a ni syad 09 delbasid e a stsal ytilibasid sO STIFENEB LANOITIDDA/LANOITPC sisongaiD laitinI recna - f emit-tsrif ro d recnac niks naht rehto recnac fo sisongaiW tifeneB ssenlle - o eno rof raey rep ecn o rof stset doolB ;recnac niks rof yspoiB .smaxe 22 f t nairavo( 521AC ,)recnac tsaerb( 3-51AC ,sedirecylgir c ;gnitseT worraM enoB ,)recnac noloc( AEC ,)recna C rof gnineercs relppoD ;ypocsonoloC ;yar-X tseh c ;esaesid ralucsav larehpirep ro sditora E ;ypocsodiomgis elbixelF ;GKE ;margoidracohc H namuH( VPH ;sisylana loots tluccome P latot( lenap dipiL ;noitaniccaV )surivamollipa c tsaerB gnidulcni ,yhpargommaM ;)tnuoc loretseloh U ;tseT paP perPnihT gnidulcni ,raemS paP ;dnuosartl S ;)amoleym rof tset( siserohportcelE nietorP mure S dna ;yhpargomrehT ;llimdaert ro ekib no tset ssert U smsyruena citroa lanimodba rof gnineercs dnuosartlP smaxE latceR latigiD dna gnitseT AS - o ;revo dna 05 ega snosrep derevoc rof raey/ecn a rof ksir hgih ta snosrep derevoc rof revo dna 04 eg p recnac etatsorS SESAESID DEIFICEP2 derevoC sesaesiD deificepS 9 - A cihportoym L ralucsuM ,)esaesiD s’girheG uoL( sisorelcS lareta D ,sisorelcS elpitluM ,sitileymoiloP ,yhportsy E ,sisolucrebuT ,sunateT ,seibaR ,sitilahpecn O lanipsorbereC ,reveF telracS ,airehthpiD ,sitileymoets M ,aimenA lleC elkciS ,sisollecurB ,sitignine T ,reveF dettopS niatnuoM ykcoR ,aimessalah L s’nesnaH ,esaesiD s’nosiddA ,esaesiD ’seriannoige D diohpyT ,)C ro B cinorhC( sititapeH ,aimeraluT ,esaesi F yramirP ,emordnyS s’eyeR ,sivarG ainehtsayM ,reve S emyL ,)esaesiD s’notyaP retlaW( sitignalohC gnisorelc D citsyC ,susotamehtyrE supuL cimetsyS ,esaesi F sisohrriC yrailiB yramirP dna ,sisorbiD SNOITINIFEA egrahC lautc -a ro tnemtaert a rof dellib tnuom s stnemyap ro stnuocsid ecnarusni yna erofeb ecivreA tsoC lautc - a no ro yb diap yllautca tnuom b eht yb tnemyap lluf sa detpecca ,uoy fo flahe p secivres ro sdoog fo redivorG 3PCV BVA A 10831MJBB stifene - B gniwollof eht rof diap stifene ( )4 dna 3 segap no detsil sa smumixam ot tcejbusPage 11

Page 12

Page 13

G 3PCV BVA A 10831MJBA .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 4202E ytilibigil - C ro esuops ruoy ,uoy edulcni yam egarevo d .62 ega rednu nerdlihc dna ,rentrap citsemoT egarevoC fo noitanimre - C rednu egarevo t eht ;delecnac si ycilop eht etad eht no sdne ycilop eh l fo yad tsal eht ;edam erew stnemyap muimerp yad tsa a ot eud deunitnoc si egarevoc sselnu ,tnemyolpme evitc T dna ylimaF ro ecnesbA fo evaeL ,ffoyaL yraropme M si ssalc ruoy ro uoy etad eht ;ecnesbA fo evaeL lacide n .elbigile regnol o S sdne egarevoc rentrap citsemod/esuop u .htaed ruoy ro pihsrentrap fo noitanimret/ecrovid nop C ega sehcaer dlihc eht nehw sdne nerdlihc rof egarevo 2 stnemeriuqer eht teem ot seunitnoc ehs ro eh sselnu ,6 o .tnedneped elbigile na fP egelivirP ytilibatro - C deunitnoc eb yam egarevo u rednu egarevoc nehw noisivorP ytilibatroP eht redn t ecnarusnI fo etacﬁitreC ruoy ot refeR .sdne ycilop eh f .sliated roP noitatimiL noitidnoC gnitsixE-er - W gnitsixe-erp a rof stﬁeneb yap ton od e c egarevoc s’nosrep taht etad eht no gninnigeb doirep htnom-21 eht gnirud noitidno s ro ecivda lacidem hcihw rof noitidnoc ro esaesid a si noitidnoc gnitsixe-erp A .strat t -21 eht nihtiw lanoisseforp lacidem a morf deviecer ro dednemmocer saw tnemtaerm neve tsixe nac noitidnoc gnitsixe-erp A .etad evitceffe eht ot roirp doirep htno t .edam neeb tey ton sah sisongaid a hguohE snoitatimiL dna snoisulcx - W recnac ot eud sessol rof tpecxe ssol yna rof yap ton od e o yb detavargga ro desuac snoitidnoc rof diap ton era stﬁeneB .esaesid deﬁiceps a r c ro recnac ot eud dedeen eb tsum secivres dna tnemtaerT .esaesid deﬁiceps a ro recna a .seirotirret sti ro setatS detinU eht ni deviecer eb dna esaesid deﬁiceps H noitatimiL maeT eraC ecipso - S ybab-llew ,slaem ro doof rof derevoc ton era secivre c .htaed s’nosrep derevoc retfa ylimaf eht rof troppus ro sreetnulov ,eraB noitatimiL steletalP dna amsalP ,dool - D doolb ro snilubolgonummi edulcni ton seo r .sronod yb decalpeS stﬁeneB sisehtsorP dna tnemtaerT latnemirepxE ro weN ,yregru - W fo %05 yap e t .ssol fo foorp sa elbaniatbo ton era segrahc cﬁiceps nehw mumixam elbacilppa ehR tﬁeneB recnaC rof yparehtomehC/noitaida - W lacimehc rehto yna :rof yap ton od e s /noitaidar htiw noitcnujnoc ni ro htiw deretsinimda eb yam hcihw ecnatsbu c dna ngised eht ;tnemeganam ro noitatlusnoc ,gninnalp tnemtaert ;yparehtomeh c fo epyt yna ;noitaluclac yrtemisod noitaidar cisab ;secived tnemtaert fo noitcurtsno l eht ;gnirotinom ro sisongaid rof desu gnigami rehto ro yar-X ;stset yrotaroba d gnidulcni seilppus ro secived yna ro ;stnemtaert eseht ot detaler stset citsongai i .stnemtaert eseht ot detaler seldeen dna snoitulos suonevartnI snoitatimiL dna snoisulcxE eraC evisnetn - B ,edicius detpmetta rof diap ton era stﬁene i ton sgurd fo ecneuﬂni eht rednu gnieb ro noitacixotni ,yrujni detciﬂni-fles lanoitnetn p rof diap ton era stﬁeneB .noitcidda gurd ro msilohocla ro ,naicisyhp a yb debircser c ,tinu erac evisnetni latipsoh a sa yfilauq ton seod taht tinu erac a ot stnemenﬁno i smoor etavirp ,erac etaidemretni ,erac evisnetni etucabus ,erac evissergorp gnidulcn w -pets rof diap ton era stﬁeneB .stinu erac ressel rehto dna nwod-pets ro ,gnirotinom htid -tsop ;smoor yrevocer lacigrus ro yrtemelet :stinu gniwollof eht ni stnemenﬁnoc nwoa ;smoor derotinom etavirp ;erac etaidemretni ;erac evissergorp ;erac aisehtsen o etavirp ro ,sdraw ,sdeb ;stinu yregrus tneitaptuo ro smoor ycnegreme ni stinu noitavresb o ton od taht seitilicaf rehto ro ;smoor yreviled ro robal ,ycnegreme ;smoor etavirp-imes r m rof diap ton era stﬁeneB .tinu erac evisnetni latipsoh nwod-pets a rof sdradnats eht tee c .etad evitceffe eht ot roirp noitazilatipsoh a gnirud gnirrucco stnemenﬁnoc suounitno C tnemenﬁnoc rof derevoc ton era etad evitceffe eht fo shtnom 01 nihtiw nrob nerdlih o rof yap ton od eW .efil s’dlihc eht fo syad 03 tsrﬁ eht gnirud gninnigeb ro gnirrucc a .tﬁeneb ecnalubmA esaesiD deﬁicepS dna recnaC eht rednu diap fi ecnalubmL SNOISULCXE DNA SNOITATIMIC SNOITACIFICEPS ETACIFITRET .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 tsugu G mrof ycilop rednu dedivorp era stifeneb recnaC puor G foereht snoitairav etats ro ,3PCV . T .ecnarusni esaesid deificeps dna recnac latnemelppus tifeneb detimil si dedivorp egarevoc eh T rof elbigile fI .yciloP tnemelppuS eracideM a ton si ycilop eh M egarevoc siht rednu stifeneb taht seriuqer wal a nehw secnatsni eb yam erehT .stifeneB etatsllA morf elbaliava ediuG s’reyuB tnemelppuS eracideM weiver ,eracide b ecnarusni htlaeh ruoy ot refer esaelp ,noitairav etats a ro ,diacideM ,eracideM rednu egarevoc evah tnedneped a ro uoy fI .uoy ot naht rehtar ytrap driht a ot diap e d .ylppa yam sneil ro stnemngissa rehtehw mrifnoc ot stnemucoT .)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 fPage 13

Page 14

G 4PICV BVA A 82831MJBC 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 14

Page 15

G 4PICV BVA A 82831MJBT 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 .6 hguorht 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 15

Page 16

INITIAL CRITICAL ILLNESS BENEFITS†PLAN 1 PLAN 2Heart Attack (100%)$10,000 $20,000Stroke (100%) $10,000 $20,000End Stage Renal Failure (100%) $10,000 $20,000Major Organ Transplant (100%) $10,000 $20,000Coronary Artery Bypass Surgery (25%)$2,500 $5,000Waiver of Premium (employee only)Yes YesCANCER CRITICAL ILLNESS BENEFITS†PLAN 1 PLAN 2Invasive Cancer (100%)$10,000 $20,000Carcinoma In Situ (25%) $2,500 $5,000REOCCURRENCE OF CRITICAL ILLNESS BENEFITS†PLAN 1 PLAN 2Initial Critical Illness(same amount as Initial Critical Illness Benefit)Yes YesCancer Critical Illness (same amount as Cancer Critical Illness Benefit)Yes YesRIDER BENEFITS PLAN 1 PLAN 2Skin Cancer Rider $250 $250Cardiopulmonary Enhancement Rider†Sudden Cardiac Arrest (25%)$2,500 $5,000Pulmonary Embolism (25%) $2,500 $5,000Pulmonary Fibrosis (25%) $2,500 $5,000Second Evaluation, Transportation and Lodging Rider Second Evaluation $1,000 $1,000 Non-Local Transportation1Air Fare $500 $500(per trip or mileS )Personal Vehicle $0.50/mi. $0.50/mi. Outpatient Lodging2 (daily)$100 $100Family Member Lodging2 (daily)$100 $100and Transportation1 (per trip or mileS) Air Fare $500 $500Personal Vehicle $0.50/mi. $0.50/mi.Specified Chronic Illness Rider† (50%)$5,000 $10,000Specified Chronic Illness or Injury Rider†Illness (50%)$5,000 $10,000Injury (100%) $10,000 $20,000Supplemental Critical Illness Rider†Advanced Alzheimer’s Disease (100%) $10,000 $20,000Advanced Parkinson’s Disease (100%)$10,000 $20,000Benign Brain Tumor (100%)$10,000 $20,000Coma (100%) $10,000 $20,000Complete Loss of Hearing (100%) $10,000 $20,000Complete Loss of Sight (100%)$10,000 $20,000Complete Loss of Speech (100%) $10,000 $20,000Paralysis (100%) $10,000 $20,000Fixed Wellness Rider (per year)$50 $501Limit of $5,000 in a calendar year. 2Limit of $1,000 in a calendar year. SMaximum of 1,000 miles.†Covered dependents receive 50% of your benefit amount.Group Critical Illness (GVCIP4)Critical Illness Insurance from Allstate BenefitsOffered to the employees of: BENEFIT AMOUNTSPercentages below are based on the Basic Benefit Amount of $10,000(Plan 1) or $20,000(Plan 2) chosen by your employer. Halifax County Public Schools with CancerG 4PICV BVA A 82831MJBPage 16

Page 17

Page 18

INITIAL CRITICAL ILLNESS BENEFITS†PLAN 3 PLAN 4Heart Attack (100%)$30,000 $40,000Stroke (100%) $30,000 $40,000End Stage Renal Failure (100%) $30,000 $40,000Major Organ Transplant (100%) $30,000 $40,000Coronary Artery Bypass Surgery (25%)$7,500 $10,000Waiver of Premium (employee only)Yes YesCANCER CRITICAL ILLNESS BENEFITS†PLAN 3 PLAN 4Invasive Cancer (100%)$30,000 $40,000Carcinoma In Situ (25%) $7,500 $10,000REOCCURRENCE OF CRITICAL ILLNESS BENEFITS†PLAN 3 PLAN 4Initial Critical Illness(same amount as Initial Critical Illness Benefit)Yes YesCancer Critical Illness (same amount as Cancer Critical Illness Benefit)Yes YesRIDER BENEFITSPLAN 3 PLAN 4Skin Cancer Rider $250 $250Cardiopulmonary Enhancement Rider†Sudden Cardiac Arrest (25%)$7,500 $10,000Pulmonary Embolism (25%) $7,500 $10,000Pulmonary Fibrosis (25%) $7,500 $10,000Second Evaluation, Transportation and Lodging RiderSecond Evaluation $1,000 $1,000Non-Local Transportation1Air Fare $500 $500(per trip or mileS)Personal Vehicle $0.50/mi. $0.50/mi.Outpatient Lodging2 (daily)$100 $100Family Member Lodging2 (daily)$100 $100and Transportation1 (per trip or mileS) Air Fare $500 $500Personal Vehicle $0.50/mi. $0.50/mi.Specified Chronic Illness Rider† (50%)$15,000 $20,000Specified Chronic Illness or Injury Rider†Illness (50%)$15,000 $20,000Injury (100%) $30,000 $40,000Supplemental Critical Illness Rider†Advanced Alzheimer’s Disease (100%) $30,000 $40,000Advanced Parkinson’s Disease (100%)$30,000 $40,000Benign Brain Tumor (100%)$30,000 $40,000Coma (100%) $30,000 $40,000Complete Loss of Hearing (100%) $30,000 $40,000Complete Loss of Sight (100%)$30,000 $40,000Complete Loss of Speech (100%) $30,000 $40,000Paralysis (100%) $30,000 $40,000Fixed Wellness Rider (per year)$50 $501Limit of $5,000 in a calendar year. 2Limit of $1,000 in a calendar year.SMaximum of 1,000 miles.†Covered dependents receive 50% of your benefit amount.Group Critical Illness (GVCIP4)Critical Illness Insurance from Allstate BenefitsBENEFIT AMOUNTSPercentages below are based on the Basic Benefit Amount of $30,000(Plan 1) or $40,000(Plan 2) chosen by your employer.Page 18WithCancer

Page 19

Page 20

G 4PICV BVA A 82831MJBB 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 - t tcerroc o n yranoroc erom ro eno fo egakcolb ro gniworra a citroa lanimodbA .tfarg ssapyb htiw seiretr b ,ymotcelobme resal ,ytsalpoigna noollab ,ssapy a lacigrus-non dna tnemecalp tnets ,ymotcereht p derevoc ton era serudecorW )ylno eeyolpme( muimerP fo revia - p evitucesnoc 09 rof delbasid fi deviaw smuimer d esaesid deificeps ro ssenlli lacitirc a ot eud syaC STIFENEB SSENLLI LACITIRC RECNA ( )setanimret egarevoc eht ,desu neeb evah stifeneb lla nehW .nosrep derevoc rep ecno diap stifeneBI recnaC evisavn - m htiw romut tnangila u dna aimekueL gnidulcni ,htworg dellortnocn L ro evisavni-non ,utis ni amonicraC .amohpmy m recnac etatsorp ylrae dna recnac niks dezisatsate a derevoc ton erC utiS nI amonicra - n ,recnac evisavni-no i dna )II ,I ,A segats( recnac etatsorp ylrae gnidulcn m rehtO .simred eht dedavni ton sah taht amonale s sa hcus( snoisel tnangilam-erp ,seicnangilam nik i dna sromut ngineb ,)aisalpoen lailehtipeartn p derevoc ton era spyloR )S(TIFENEB SSENLLI LACITIRC FO ECNERRUCCOE ( )setanimret egarevoc eht ,desu neeb evah stifeneb lla nehW .nosrep derevoc rep ecno diap stifeneBI ssenllI lacitirC laitin - s erom sisongaid dnoce t rof sisongaid fo etad tsrif eht retfa shtnom 6 nah w diap saw tifeneb ssenllI lacitirC laitinI na hcihC ssenllI lacitirC recna - s erom sisongaid dnoce t saw tnemtaert etad tsal eht retfa shtnom 6 nah r tifeneb ssenllI lacitirC recnaC a hcihw rof deviece w diap saR STIFENEB REDIS rediR recnaC nik - i lasab fo sisongaid sedulcn c tsuM .amonicrac llec suomauqs dna amonicrac lle n tnangilaM .syad 563 nihtiw diap neeb evah to m sa hcus snoitidnoc suorecnac-erp dna amonale l ;aisalprepyh ;dionicrac ;sisotarek cinitca ;aikalpokue p ;selom ;amonalem tnangilam-non ;aimehtycylo a derevoc ton era snoisel ro sesaesid ralimis dnC rediR tnemecnahnE yranomlupoidra - o ecn p nosrep derevoc rep ssenlli re• tserrA caidraC nedduS - p eht si ti fi elbayap traeh( noitcrafni laidracoyM .sisongaid yramir a derevoc ton si )kcatt• msilobmE yranomluP • sisorbiF yranomluP S dna noitatropsnarT ,noitaulavE dnoce L rediR gnigdo - • noitaulavE dnoceS - m ot roirp deniatbo eb tsus rehto naicisyhp a yb dna tnemtaert ro yregru t dnoces enO .naicisyhp tnerruc ruoy nah e tnemtaert ro yregrus rep noitaulav• noitatropsnarT lacoL-noN - 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 20

Page 21

G 4PICV BVA A 82831MJBA .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 S gnigdoL dna noitatropsnarT ,noitaulavE dnoceS ;REC4PICG rediR tnemecnahnE yranomlupoidraC ;RCS4PICG rediR recnaC nik R ;2RS4PICG rediR ssenllI lacitirC latnemelppuS ;R2CS4PICG rediR yrujnI ro ssenllI cinorhC deificepS ;R1CS4PICG rediR ssenllI cinorhC deificepS ;RES4PICG redi F .RWF4PICG rediR ssenlleW dexiT .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 f C 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 yciloI stﬁeneb ,egarevoc fo etad evitceffe eht erofeb srucco recnac fo sisongaid tsrﬁ eht f a eht ot tcejbus ,etad evitceffe eht retfa recnac fo sisongaid tneuqesbus a rof diap er t .etacﬁitrec eht ni snoitidnoc dna smreE 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 21

Page 22

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

Page 23

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

Page 24

INITIAL CRITICAL ILLNESS BENEFITS†PLAN 1 PLAN 2Heart Attack (100%)$10,000 $20,000Stroke (100%) $10,000 $20,000End Stage Renal Failure (100%) $10,000 $20,000Major Organ Transplant (100%) $10,000 $20,000Coronary Artery Bypass Surgery (25%)$2,500 $5,000Waiver of Premium (employee only)Yes YesREOCCURRENCE OF CRITICAL ILLNESS BENEFITS†PLAN 1 PLAN 2Initial Critical Illness(same amount as Initial Critical Illness Benefit)Yes YesRIDER BENEFITS PLAN 1 PLAN 2Cardiopulmonary Enhancement Rider†Sudden Cardiac Arrest (25%)$2,500 $5,000Pulmonary Embolism (25%) $2,500 $5,000Pulmonary Fibrosis (25%) $2,500 $5,000Second Evaluation, Transportation and Lodging Rider Second Evaluation $1,000 $1,000 Non-Local Transportation1Air Fare $500 $500(per trip or mileS )Personal Vehicle $0.50/mi. $0.50/mi. Outpatient Lodging2 (daily)$100 $100Family Member Lodging2 (daily)$100 $100and Transportation1 (per trip or mileS) Air Fare $500 $500Personal Vehicle $0.50/mi. $0.50/mi.Specified Chronic Illness Rider† (50%)$5,000 $10,000Specified Chronic Illness or Injury Rider†Illness (50%)$5,000 $10,000Injury (100%) $10,000 $20,000Supplemental Critical Illness Rider†Advanced Alzheimer’s Disease (100%) $10,000 $20,000Advanced Parkinson’s Disease (100%)$10,000 $20,000Benign Brain Tumor (100%)$10,000 $20,000Coma (100%) $10,000 $20,000Complete Loss of Hearing (100%) $10,000 $20,000Complete Loss of Sight (100%)$10,000 $20,000Complete Loss of Speech (100%) $10,000 $20,000Paralysis (100%) $10,000 $20,000Fixed Wellness Rider (per year)$50 $501Limit of $5,000 in a calendar year. 2Limit of $1,000 in a calendar year. SMaximum of 1,000 miles.†Covered dependents receive 50% of your benefit amount.Group Critical Illness (GVCIP4)Critical Illness Insurance from Allstate BenefitsOffered to the employees of: BENEFIT AMOUNTSPercentages below are based on the Basic Benefit Amount of $10,000(Plan 1) or $20,000(Plan 2) chosen by your employer. Halifax County Public Schools without CancerG 4PICV BVA A 63831MJBPage 24

Page 25

Page 26

INITIAL CRITICAL ILLNESS BENEFITS†PLAN 3 PLAN 4Heart Attack (100%)$30,000 $40,000Stroke (100%) $30,000 $40,000End Stage Renal Failure (100%) $30,000 $40,000Major Organ Transplant (100%) $30,000 $40,000Coronary Artery Bypass Surgery (25%)$7,500 $10,000Waiver of Premium (employee only)Yes YesREOCCURRENCE OF CRITICAL ILLNESS BENEFITS†PLAN 3 PLAN 4Initial Critical Illness(same amount as Initial Critical Illness Benefit)Yes YesRIDER BENEFITSPLAN 3 PLAN 4Cardiopulmonary Enhancement Rider†Sudden Cardiac Arrest (25%)$7,500 $10,000Pulmonary Embolism (25%) $7,500 $10,000Pulmonary Fibrosis (25%) $7,500 $10,000Second Evaluation, Transportation and Lodging RiderSecond Evaluation $1,000 $1,000Non-Local Transportation1Air Fare $500 $500(per trip or mileS)Personal Vehicle $0.50/mi. $0.50/mi.Outpatient Lodging2 (daily)$100 $100Family Member Lodging2 (daily)$100 $100and Transportation1 (per trip or mileS) Air Fare $500 $500Personal Vehicle $0.50/mi. $0.50/mi.Specified Chronic Illness Rider† (50%)$15,000 $20,000Specified Chronic Illness or Injury Rider†Illness (50%)$15,000 $20,000Injury (100%) $30,000 $40,000Supplemental Critical Illness Rider†Advanced Alzheimer’s Disease (100%) $30,000 $40,000Advanced Parkinson’s Disease (100%)$30,000 $40,000Benign Brain Tumor (100%)$30,000 $40,000Coma (100%) $30,000 $40,000Complete Loss of Hearing (100%) $30,000 $40,000Complete Loss of Sight (100%)$30,000 $40,000Complete Loss of Speech (100%) $30,000 $40,000Paralysis (100%) $30,000 $40,000Fixed Wellness Rider (per year)$50 $501Limit of $5,000 in a calendar year. 2Limit of $1,000 in a calendar year.SMaximum of 1,000 miles.†Covered dependents receive 50% of your benefit amount.Group Critical Illness (GVCIP4)Critical Illness Insurance from Allstate BenefitsBENEFIT AMOUNTSPercentages below are based on the Basic Benefit Amount of $30,000(Plan 1) or $40,000(Plan 2) chosen by your employer.Page 26WithoutCancer

Page 27

Page 28

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 - t tcerroc o n yranoroc erom ro eno fo egakcolb ro gniworra a citroa lanimodbA .tfarg ssapyb htiw seiretr b ,ymotcelobme resal ,ytsalpoigna noollab ,ssapy a lacigrus-non dna tnemecalp tnets ,ymotcereht p derevoc ton era serudecorW )ylno eeyolpme( muimerP fo revia - p evitucesnoc 09 rof delbasid fi deviaw smuimer d esaesid deificeps ro ssenlli lacitirc a ot eud syaR )S(TIFENEB SSENLLI LACITIRC FO ECNERRUCCOE ( )setanimret egarevoc eht ,desu neeb evah stifeneb lla nehW .nosrep derevoc rep ecno diap stifeneBI ssenllI lacitirC laitin - s erom sisongaid dnoce t rof sisongaid fo etad tsrif eht retfa shtnom 6 nah w diap saw tifeneb ssenllI lacitirC laitinI na hcihR STIFENEB REDIC rediR tnemecnahnE yranomlupoidra - o ecn p nosrep derevoc rep ssenlli re• tserrA caidraC nedduS - p eht si ti fi elbayap traeh( noitcrafni laidracoyM .sisongaid yramir a derevoc ton si )kcatt• msilobmE yranomluP • sisorbiF yranomluP S dna noitatropsnarT ,noitaulavE dnoce L rediR gnigdo - • noitaulavE dnoceS - m ot roirp deniatbo eb tsus rehto naicisyhp a yb dna tnemtaert ro yregru t dnoces enO .naicisyhp tnerruc ruoy nah e tnemtaert ro yregrus rep noitaulav• noitatropsnarT lacoL-noN - 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 28

Page 29

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 29

Page 30

GROUP VOLUNTARY HOSPITAL INDEMNITY INSURANCE BENEFIT HIGHLIGHTS Hospital Indemnity (HI) insurance pays a cash benefit if you or an insured dependent (spouse or child) are confined in a hospital for a covered illness or injury. It also provides additional daily benefits for related services. Even with the best primary health insurance plan, out-of-pocket costs from a hospital stay can add up. The benefits are paid in lump sum amounts to you and 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.). The average cost for a hospital stay is $2,607 per day1 COVERAGE INFORMATION Benefit amounts are based on the plan in effect for you or an insured dependent at the time the covered event occurs. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). PLAN INFORMATION PLAN 1 PLAN 2 Covered Events Illness and injury Illness and injury HSA Compatible Yes Yes BENEFITS HOSPITAL CARE2PLAN 1 PLAN 2 First Day Hospital Confinement Up to 1 day per year $1,000 $1,000 Daily Hospital Confinement (Day 2+) Up to 30 days per year $150 $200 Daily ICU Confinement (Day 2+) Up to 10 days per year $200 $250 Medical Travel Up to 2 days per year $100 $100 Companion Lodging Up to 10 days per year $100 $100 Continuous Care Confinement (Rehab, Skilled Nursing & Hospice) Up to 10 days per year $150 $200 Newborn Routine Hospital Care Once/Live Birth $150 $150 FAMILY CARE PLAN 1 PLAN 2 Health Screening Once per year $ 50 $ 50 FEATURES PLAN 1 PLAN 2 Ability Assist® EAP3 – 24/7/365 access to help for financial, legal or emotional issues Included Included HealthChampion S M4 – Administrative & clinical support following serious illness or injury Included Included Page 30

Page 31

GROUP VOLUNTARY HOSPITAL INDEMNITY INSURANCE BENEFIT HIGHLIGHTS Annual Open Enrollment Monthly Rates – Employee Paid Plan 1 Plan 2 Employee $20.62 $25.26 Employee & Spouse/Partner $39.96 $49.05 Employee & Child(ren) $32.07 $38.24 Family $52.09 $64.22 ASKED & ANSWERED IS THIS COVERAGE HSA COMPATIBLE? If you (or any dependent(s)) currently participate in a Health Saving Account (HSA) or if you plan to do so in the future, you should be aware that the IRS limits the types of supplemental insurance you may have in addition to a HSA, while still maintaining the tax-exempt status of the HSA. This plan design was designed to be compatible with Health Savings Accounts (HSAs). However, if you have or plan to open an HSA, please consult your tax and legal advisors to determine which supplemental benefits may be purchased by employees with an HSA. 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. 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. WHEN CAN I ENROLL? You may enroll during any scheduled enrollment period. WHEN DOES THIS INSURANCE BEGIN? Subject to any eligibility waiting period established by your employer, insurance will become effective in accordance with the terms of the certificate (usually the first day of the month following the date you elect coverage). 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), unless already insured with the prior carrier. 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. Your spouse/partner may also continue insurance in certain circumstances. Page 31

Page 32

Reference 1“Kaiser Family Foundation, November 2019. Adjusted expenses per inpatient day include expenses incurred for both inpatient and outpatient care; inpatient days are adjusted higher to reflect an estimate of the volume of outpatient services: https://www.kff.org/health-costs/state-indicator/expenses-per-inpatient-day, viewed as of 4/16/2021. 2For Hospital Care benefits, when an insured is eligible for more than one benefit in a single day, only the highest benefit will be paid. 3AbilityAssist® services are offered through The Hartford by ComPsych®. ComPsych is not affiliated with The Hartford and is not a provider of insurance services. The Hartford is not responsible and assumes no liability for the goods and services provided by ComPsych and reserves the right to discontinue any of these services at any time. Services may not be available in all states. Visit https://www.thehartford.com/employee-benefits/value-added-services for more information. 4HealthChampionSM services are provided through The Hartford by ComPsych®. ComPsych is not affiliated with The Hartford and is not a provider of insurance services. The Hartford is not responsible and assumes no liability for the goods and services provided by ComPsych and reserves the right to discontinue these services at any time. Services may not be available in all states. Visit https://www.thehartford.com/employee-benefits/value-added-services for more information. HealthChampion SM 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. 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. Policies underwritten by the underwriting company listed above detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued. This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy apply. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder. Benefits are subject to state availability. © 2020 The Hartford. Hospital does not include: convalescent homes, or convalescent, rest or nursing facilities; facilities affording primarily custodial, educational or rehabilitation care; or facilities primarily for care of the aged/elderly, persons with substance abuse issues/disorders or mental/nervous disorders. Confinement means the assignment to a bed in a medical facility for a period of at least 20 consecutive hours. Required hours may vary by state. The Hartford compensates both internal and external producers, as well as others, for the sale and service of our products. For additional information regarding Hartford’s compensation practices, please review our website http://thehartford.com/group-benefits-producer-compensation. Hospital Indemnity Form Series includes GBD-2800, GBD-2900, or state equivalent. - 5 962h NS 08/21 Page 32

Page 33

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 HOSPITAL INDEMNITY INSURANCE - LIMITATIONS AND EXCLUSIONS The benefits payable are based on the insurance in effect on the date of the covered event, 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. Other Hospital Indemnity Policy Limitation (Over-insurance Limitation): If an employee is insured under any other hospital indemnity policy underwritten by The Hartford, any claim for benefit is only payable under the one policy elected by the employee (or beneficiary or estate, in the event of death). We will return the amount of premium paid for any other policy that is declined by the employee retroactive to the later of:  the last date any benefit was paid for any covered person under the other policy  the effective date of insurance for the employee under the other policy Exclusions. 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 intentional self-infliction  Voluntary intoxication (as defined by the law of the jurisdiction in which the illness or injury occurred) or while under the influence of any narcotic, drug or controlled substance, unless administered by or taken according to the instruction of a physician or medical professional  Voluntary intoxication through use of poison, gas or fumes, whether by ingestion, injection, inhalation or absorption  Voluntary commission of or attempt to commit a felony, voluntary participation in illegal activities (except for misdemeanor 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-paying passenger in a commercial aircraft (other than a charter airline) on a regularly scheduled passenger flight or while 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, free diving, free running, hang gliding, ice climbing, Jai Alai, jet powered flight, kite surfing, kiteboarding, luging, missed climbing, 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, speed riding, 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, unless specifically allowed by a provision of the certificate  Involvement in any declared or undeclared war or act of war (not including acts of terrorism), while serving in the military or an auxiliary unit attached to the military, or working in an area of war whether voluntarily or as required by an employer This insurance also does not provide benefits, 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 certificate  Substance abuse, unless specifically allowed by a provision of the certificate  Medical mishap or negligence on the part of any physician, medical professional, or therapist, including malpractice  Treatment, supplies or services provided by, through or, behalf of any government agency or program; unless payment is required by a covered person  Custodial care, unless specifically allowed by a benefit provision in the certificate or any rider attached to the policy (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 an accident -Treatment necessary due to congenital disease or anomaly Exclusions will vary by the jurisdiction/state in which the policy is issued. NOTICES THIS IS A HOSPITAL CONFINEMENT INDEMNITY POLICY AND PROVIDES LIMITED BENEFITS. 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 policy provides limited benefits health 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. The Policy may provide payment of several benefits as a result of claims from a single hospitalization or covered incident. Payment of one benefit under the Policy does not constitute acceptance of liability for all claims made under the Policy nor does it prohibit Us from further investigation of subsequent claims. Please note: For residents of CA, GA, NJ and NY, since this is a limited benefit health product, persons without comprehensive health benefits from an individual or group health insurance policy or an HMO, or an employer plan providing essential health benefits are not eligible for this insurance. For residents of CT, ID, ME, NH, and WV, a person covered by any Title XIX program (Medicaid or any similar name) is not eligible for this insurance. 5962h NS 05/21. Hospital Income Plan Form Series includes GBD-2800, GBD-2900, or state equivalent. Page 33

Page 34

G IDV VA A 30831MJBD ecnarusnI ytilibasi P yrujni boj-eht-ffo ro ssenkcis a morf delbasid era uoy fi tifeneb ylhtnom a sedivorI .revocer ot uoy rof tiaw t’now sllib ylhtnom ruoy dna — emit emos rof krow ot elba eb ton yam uoy ,tnedicca na evah ro kcis teg uoy fD .htlaeh laicnanif ruoy tcetorp dna emocni tsol ruoy ecalper uoy pleh nac stifeneB etatsllA morf ecnarusnI ytilibasiH skroW tI woH s’ere• ruoy retfa yad tsrif eht trats stifeneBe nehw ,doirep )gnitiaw( noitanimilt krow tonnac uoy dna delbasid yllato• eb nac dna elbadroffa era smuimerPc detcuded lloryap yltneinevno• evael uoy fi uoy htiw og yam egarevoCy ^egarevoc slecnac reyolpme ro boj ruo• eht steem eht tifeneb ylhtnom a tceleSn ylimaf ruoy dna uoy fo sdee• tifeneb a eviecer uoy ,delbasid yllatot fIa htnom hcae tnuom• aiv tifeneb hsac ylhtnom a eviecer uoYc nac uoy taht tisoped tcerid ro kcehu hsiw uoy revewoh esY – sgnivas ruoy rof drah dekrow ev’uo d .tuo meht epiw ytilibasid a tel t’no• sgnivas dna gnikcehc ruoy tcetorP• )k(104 ro ASH ruoy otni pid t’noDP secnaniF ruoY gnitcetorM sdeeN ruoY gniteeT SIHT TUOBA KNIHI ,serutcarf sa hcus seirujn s eht era sniarts dna sniarp m mret-trohs nommoc tso d *smialc ytilibasi J fo 4 ni 1 revo tsu t sdlo-raey-02 s’yado w delbasid emoceb lli b *eriter yeht erofe M fo %04 naht ero A droffa tonnac snacirem t detcepxenu na yap o $ **llib lacidem 005 * .0202 ,weivrevo/gro.neppahnacytilibasid ,ssenerawA ytilibasiD rof licnuoC ,ytilibasiD fo secnahC * dnA tuobA seirroW cilbuP :etoN ataD“ ,noitadnuoF ylimaF resiaK* E /794c1f1/gro.ffk.www//:sptth ”,slliB lacideM esirpruS htiW ecneirepx ^ .sliated rof etacifitrec ruoy ot refeR Page 34

Page 35

G IDV VA A 30831MJBT 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 reh rof yap pleh na f ,sesnepxe gnivil s'ylima s ,yticirtcele ,sllib sa hcu a sag dnF secnaniC ,sASH tcetorp pleh na s snalp tnemeriter ,sgniva a morf s)k(104 dnb detelped gnieC ESOOHU ESJ .tnemllornE nepO s’reyolpme reh gnirud ecnarusnI ytilibasiD stﬁeneB etatsllA rof pu dengis naoJ gnipeek elihw ,sesnepxe gnivil reh teem ot tifeneb ylhtnom a seviecer dna egarevoc ytilibasiD stifeneB etatsllA reh no mialc a selif nao t ,latrop bew tneinevnoc eht gnissecca yb egarevoc reh fo kcar M .*stifeneByS :rof stifeneb hsac seviecer ehC MIAL• :tifeneB ecnarusnI ytilibasiDylhtnom diaPT .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 roM naoJ 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 reh s’ereH .esuoh reh gnitniap elihw reddal a ffo sllaf naoJ ,retal shtnom wef H stifeneb hsac reh esu nac naoJ syaw eht fo emos era ereA ecnalubmJ eht stisiv nao e dna moor ycnegrem i yb denimaxe sa rotcod D sisongaiS htiw desongaid si eh a dna csid nrot s deludehcs si yregru t niap reh eveiler oC mialS trohS reh selif eh T mialc ytilibasiD mre o ot roirp eniln u yregrus gniogrednS yregruS demrofrep si yregru a desaeler si naoJ dn f ot latipsoh eht mor r emoh ta revoceR yrevoceJ pu-wollof sah nao v rotcod reh htiw stisi d keew xis a gniru r doirep yrevocePage 35

Page 36

Group Voluntary Disability Income (Virginia) Product Illustration Industry Class: Preferred Platinum Accident Elimination Period: 14 days Benefit Period: 12 Months Sickness Elimination Period: 14 days Portability: Yes Premium Mode: Monthly SIC Code: 8211 Additional Features: Portability Privilege Monthly Issue Ages Benefit 18-4950-5960-6465-6970 + $400 $14.83 $19.64 $27.07 $28.69 $33.40 $500 $18.54 $24.55 $33.84 $35.87 $41.75 $600 $22.25 $29.45 $40.61 $43.04 $50.10 $700 $25.96 $34.36 $47.38 $50.21 $58.46 $800 $29.67 $39.27 $54.15 $57.39 $66.81 $900 $33.37 $44.18 $60.91 $64.56 $75.16 $1,000 $37.08 $49.09 $67.68 $71.73 $83.51 $1,100 $40.79 $54.00 $74.45 $78.91 $91.86 $1,200 $44.50 $58.91 $81.22 $86.08 $100.21 $1,300 $48.21 $63.82 $87.99 $93.25 $108.56 $1,400 $51.92 $68.73 $94.76 $100.43 $116.91 $1,500 $55.62 $73.64 $101.52 $107.60 $125.26 $1,600 $59.33 $78.55 $108.29 $114.77 $133.61 $1,700 $63.04 $83.46 $115.06 $121.95 $141.96 $1,800 $66.75 $88.36 $121.83 $129.12 $150.31 $1,900 $70.46 $93.27 $128.60 $136.29 $158.67 $2,000 $74.17 $98.18 $135.37 $143.47 $167.02 $2,100 $77.87 $103.09 $142.13 $150.64 $175.37 $2,200 $81.58 $108.00 $148.90 $157.81 $183.72 $2,300 $85.29 $112.91 $155.67 $164.99 $192.07 $2,400 $89.00 $117.82 $162.44 $172.16 $200.42 $2,500 $92.71 $122.73 $169.21 $179.33 $208.77 $2,600 $96.42 $127.64 $175.98 $186.51 $217.12 $2,700 $100.12 $132.55 $182.74 $193.68 $225.47 $2,800 $103.83 $137.46 $189.51 $200.85 $233.82 $2,900 $107.54 $142.37 $196.28 $208.03 $242.17 $3,000 $111.25 $147.27 $203.05 $215.20 $250.52 $3,100 $114.96 $152.18 $209.82 $222.37 $258.88 $3,200 $118.67 $157.09 $216.59 $229.55 $267.23 $3,300 $122.37 $162.00 $223.35 $236.72 $275.58 $3,400 $126.08 $166.91 $230.12 $243.89 $283.93 $3,500 $129.79 $171.82 $236.89 $251.07 $292.28 $3,600 $133.50 $176.73 $243.66 $258.24 $300.63 $3,700 $137.21 $181.64 $250.43 $265.41 $308.98 $3,800 $140.92 $186.55 $257.20 $272.59 $317.33 $3,900 $144.62 $191.46 $263.96 $279.76 $325.68 $4,000 $148.33 $196.37 $270.73 $286.93 $334.03 $4,100 $152.04 $201.28 $277.50 $294.11 $342.38 $4,200 $155.75 $206.18 $284.27 $301.28 $350.73 $4,300 $159.46 $211.09 $291.04 $308.45 $359.09 $4,400 $163.17 $216.00 $297.81 $315.63 $367.44 $4,500 $166.87 $220.91 $304.57 $322.80 $375.79 $4,600 $170.58 $225.82 $311.34 $329.97 $384.14 $4,700 $174.29 $230.73 $318.11 $337.15 $392.49 $4,800 $178.00 $235.64 $324.88 $344.32 $400.84 $4,900 $181.71 $240.55 $331.65 $351.49 $409.19 $5,000 $185.42 $245.46 $338.42 $358.67 $417.54 This rate illustration is incomplete and cannot be used without the accompanying proposal illustration pages that provide a complete description of all benefits, limitations and exclusions. This illustration does not validate income rules for any States. The Maximum Monthly Benefit that can be applied for must be reduced by the Monthly Benefits of all other existing coverage. This illustration and rates expire: 9/3/2024. This information highlights some features of the policy but is not the insurance contract. For complete details, contact your Allstate Benefits Agent. This is a brief overview of the benefits available under the Group Voluntary Policy underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL). Details of the insurance, including exclusions, restrictions and other provisions are included in the policy and/or certificates issued. 06/24/2024G IDV VA A 30831MJBPage 36

Page 37

Group Voluntary Disability Income (Virginia) Product Illustration Industry Class: Preferred Platinum Accident Elimination Period: 30 days Benefit Period: 12 Months Sickness Elimination Period: 30 days Portability: Yes Premium Mode: Monthly SIC Code: 8211 Additional Features: Portability Privilege Monthly Issue Ages Benefit 18-4950-5960-6465-6970 + $400 $9.61 $13.63 $16.08 $17.00 $20.33 $500 $12.01 $17.04 $20.10 $21.25 $25.41 $600 $14.41 $20.44 $24.12 $25.50 $30.49 $700 $16.82 $23.85 $28.14 $29.76 $35.57 $800 $19.22 $27.26 $32.16 $34.01 $40.65 $900 $21.62 $30.67 $36.18 $38.26 $45.73 $1,000 $24.02 $34.07 $40.20 $42.51 $50.82 $1,100 $26.43 $37.48 $44.22 $46.76 $55.90 $1,200 $28.83 $40.89 $48.24 $51.01 $60.98 $1,300 $31.23 $44.30 $52.26 $55.26 $66.06 $1,400 $33.63 $47.70 $56.28 $59.51 $71.14 $1,500 $36.04 $51.11 $60.30 $63.76 $76.22 $1,600 $38.44 $54.52 $64.32 $68.01 $81.31 $1,700 $40.84 $57.93 $68.34 $72.26 $86.39 $1,800 $43.24 $61.33 $72.36 $76.51 $91.47 $1,900 $45.65 $64.74 $76.38 $80.77 $96.55 $2,000 $48.05 $68.15 $80.40 $85.02 $101.63 $2,100 $50.45 $71.56 $84.42 $89.27 $106.71 $2,200 $52.85 $74.96 $88.44 $93.52 $111.80 $2,300 $55.26 $78.37 $92.46 $97.77 $116.88 $2,400 $57.66 $81.78 $96.48 $102.02 $121.96 $2,500 $60.06 $85.19 $100.50 $106.27 $127.04 $2,600 $62.46 $88.59 $104.52 $110.52 $132.12 $2,700 $64.87 $92.00 $108.54 $114.77 $137.20 $2,800 $67.27 $95.41 $112.56 $119.02 $142.29 $2,900 $69.67 $98.82 $116.58 $123.27 $147.37 $3,000 $72.07 $102.22 $120.60 $127.52 $152.45 $3,100 $74.48 $105.63 $124.62 $131.78 $157.53 $3,200 $76.88 $109.04 $128.64 $136.03 $162.61 $3,300 $79.28 $112.45 $132.66 $140.28 $167.69 $3,400 $81.68 $115.85 $136.68 $144.53 $172.78 $3,500 $84.09 $119.26 $140.70 $148.78 $177.86 $3,600 $86.49 $122.67 $144.72 $153.03 $182.94 $3,700 $88.89 $126.08 $148.74 $157.28 $188.02 $3,800 $91.29 $129.48 $152.76 $161.53 $193.10 $3,900 $93.70 $132.89 $156.78 $165.78 $198.18 $4,000 $96.10 $136.30 $160.80 $170.03 $203.27 $4,100 $98.50 $139.71 $164.82 $174.28 $208.35 $4,200 $100.90 $143.11 $168.84 $178.53 $213.43 $4,300 $103.31 $146.52 $172.86 $182.79 $218.51 $4,400 $105.71 $149.93 $176.88 $187.04 $223.59 $4,500 $108.11 $153.34 $180.90 $191.29 $228.67 $4,600 $110.51 $156.74 $184.92 $195.54 $233.76 $4,700 $112.92 $160.15 $188.94 $199.79 $238.84 $4,800 $115.32 $163.56 $192.96 $204.04 $243.92 $4,900 $117.72 $166.97 $196.98 $208.29 $249.00 $5,000 $120.12 $170.37 $201.00 $212.54 $254.08 This rate illustration is incomplete and cannot be used without the accompanying proposal illustration pages that provide a complete description of all benefits, limitations and exclusions. This illustration does not validate income rules for any States. The Maximum Monthly Benefit that can be applied for must be reduced by the Monthly Benefits of all other existing coverage. This illustration and rates expire: 9/3/2024. This information highlights some features of the policy but is not the insurance contract. For complete details, contact your Allstate Benefits Agent. This is a brief overview of the benefits available under the Group Voluntary Policy underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL). Details of the insurance, including exclusions, restrictions and other provisions are included in the policy and/or certificates issued. 06/24/2024G IDV VA A 30831MJBPage 37

Page 38

G IDV VA A 30831MJBB stifene - B snoitidnoc gniwollof eht rof diap tifene ( )5 dna 4 ,3 segap no detsil sa smumixam ot tcejbusB STIFENEB YCILOP ESA T ytilibasiD lato - t retfa strats tifeneb ylhtnom eh t lliw stifeneB .tem neeb sah doirep noitanimile eh n doirep tifeneb mumixam eht dnoyeb eunitnoc toP ytilibasiD laitra - 5 si tifeneb ylhtnom eht fo %0 p latoT eht taht htnom eno tsael ta retfa dia D eunitnoc stnemyaP .elbayap si tifeneB ytilibasi w ton tub ,shtnom 3 ot pu rof delbasid yllaitrap elih b doirep tifeneb mumixam eht dnoyeP ycnanger - a latot fi diap si ycnangerp rof tifeneb d neeb sah etacifitrec eht retfa snigeb tsrif ytilibasi i shtnom 9 tsael ta rof ecrof nO ronoD nagr - a delbasid nehw diap si tifeneb f nagro na gnitanod morW muimerP fo revia - p retfa deviaw era smuimer m syad 03 rof elbayap era stifeneb ytilibasid ylhtno i era stifeneb ylhtnom sa gnol sa rof ,wor a n p elbayaB SNOITIDNOC STIFENEB YCILOP ESA C ytilibasiD tnerrucno - o si tifeneb ylhtnom en p eno naht erom ot eud delbasid era uoy fi neve ,dia c esuac eno naht erom morf delbasid gnieB .esua d eht rednu stifeneb fo tnemyap eht dnetxe ton seo m doirep tifeneb mumixaR ytilibasiD tnerruce - a fi diap si tifeneb d 6 nihtiw esuac detaler ro emas eht morf delbasi m mumixam ro doirep gnitiaw wen a tuohtiw shtno b doirep tifeneO 1 noitpM tifeneB ylhtnoM mumixa -$5 000, B doireP tifene - 1 shtnoM 2E tnediccA rof doireP noitanimil - 1 syaD 4E ssenkciS rof doireP noitanimil - 1 syaD 4O 2 noitpM tifeneB ylhtnoM mumixa -$5 000, B doireP tifene - 2 shtnoM 4E tnediccA rof doireP noitanimil - 3 syaD 0E ssenkciS rof doireP noitanimil - 3 syaD 0D EGAREVOC FO SLIATEM tifeneB ylhtno - Y edulcni hcihw emocni fo secruos elbitcuded rehto morf stnemyap ytilibasid eviecer uoy fi decuder eb yam tifeneb ytilibasid ylhtnom ruo i ecnediser fo etats ruoy fi detceffa eb osla yam tifeneb ylhtnom ruoy fo noitaluclac ehT .egarevoc ecnarusni puorg rehto ro seicilop emocni ytilibasid laudividn m .ecnarusni ytilibasid etats setadnaD SNOITINIFET ytilibasiD lato - d uoy ,yrujni ro ssenkcis a ot eu a laitnatsbus dna lairetam eht mrofrep ot elbanu :er d raluger eht rednu ;noitapucco nwo ruoy fo seitu c rof boj yna ni gnikrow ton dna ;rotcod a fo era w tiforp ro egaP ytilibasiD laitra - d ,yrujni ro ssenkcis a ot eu y dna lairetam eht mrofrep ot elbanu :era uo s -lluf a no noitapucco nwo ruoy fo seitud laitnatsbut dna ;emit-trap krow ot elba era tub ,sisab emi u rotcod a fo erac raluger eht rednE doireP )gnitiaW( noitanimil - a fo doirep c deifsitas eb tsum hcihw ytilibasid latot suounitno b stifeneb eviecer ot elbigile era uoy erofeO noitapuccO nw - t era uoy noitapucco eh p snigeb ytilibasid fo doirep a nehw gnimrofrePage 38

Page 39

G IDV VA A 30831MJBA .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 ,PIDVG mrof ycilop rednu dedivorp era stifeneb ytilibasiD mreT trohS puor T .)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 stifeneC 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 dekroT dna ylimaF ro ,ecnesbA fo evaeL ,ffoyaL yraropme M noisivorP ecnesbA fo evaeL lacide - W lliw e c ruoy htiw ecnadrocca ni egarevoc ruoy eunitno e ffoyal yraropmet no ycilop ecruoser namuh s'reyolpm o dna eunitnoc stnemyap muimerp fi ecnesba fo evael r y uoy fI .gnitirw ni evael ruoy devorppa reyolpme ruo a egarevoc ,ecnesba fo evael ro ffoyal yraropmet no er w evitca desaec uoy retfa shtnom 3 rof deunitnoc eb lli e fo evaeL lacideM dna ylimaF no era uoy fI .tnemyolpm A ni era uoy hguoht sa eunitnoc lliw egarevoc ,ecnesb a .tnemyolpme evitcI ton seod ycilop ecruoser namuh s'reyolpme ruoy f p ylimaf a gnirud egarevoc ruoy fo noitaunitnoc rof edivor a eb lliw egarevoc ruoy ,ecnesba fo evael lacidem dn r .tnemyolpme evitca ot nruter uoy nehw detatsnieW wen a ylppa ,doirep gnitiaw wen a ylppa ton lliw e p ecnedive eriuqer ro ,noisulcxe snoitidnoc gnitsixe-er o .ytilibarusni fW sdnE egarevoC neh - C ycilop eht rednu egarevo e si ycilop puorg eht etad eht :fo tseilrae eht no sdn c muimerp hcihw rof doirep eht fo yad tsal eht ;delecna p evitca ni era uoy yad tsal eht ;edam erew stnemya e yraropmeT eht rednu dedivorp sa tpecxe ,tnemyolpm L evaeL lacideM dna ylimaF ro ecnesbA fo evaeL ,ffoya o na ni regnol on era uoy etad eht ;noisivorp ecnesbA f e regnol on si ssalc ruoy ro uoy etad eht ;ssalc elbigil e si noitatneserpersim lairetam ro duarf ro ;elbigil d .derevocsiP egelivirP ytilibatro - C deunitnoc eb yam egarevo u rednu egarevoc nehw noisivorP ytilibatroP eht redn t ecnarusnI fo etacﬁitreC ruoy ot refeR .sdne ycilop eh f .sliated roP noitatimiL noitidnoC gnitsixE-er - B strats taht ytilibasid a rof diap ton era stﬁene w -erp a evah uoY .noitidnoc gnitsixe-erp a morf etad evitceffe ruoy fo shtnom 21 nihtie ;etad evitceffe eht retfa shtnom 21 eht gnirud nageb ytilibasid eht fi noitidnoc gnitsix a citsongaid ,secivres ro erac ,noitatlusnoc ,tnemtaert lacidem deviecer uoy dn m 21 eht ni snoitadnemmocer tnemtaert dewollof ro snoitacidem koot ro ,serusae m saw stﬁeneb ni esaercni na etad eht ro ,egarevoc fo etad evitceffe eht ot roirp shtno e etad eht ro etad evitceffe eht ot roirp shtnom 21 eht ni detsixe smotpmys ro ;evitceff a .evitceffe saw stﬁeneb ni esaercni nE snoisulcx - W noitapicitrap ro raw :morf gnitluser seitilibasid rof stﬁeneb yap ton od e i ;noitapucco lagelli na ni noitapicitrap ro seitivitca lagelli ;noilleber ro noitcerrusni ,toir a n i -eraf a sselnu scituanorea ni noitapicitrap ;noitca ro yrujni detciﬂni-fles yllanoitnetnp ro semuf gnilahni yliratnulov ;tfarcria reirrac-nommoc desnecil a no regnessap gniya g eht gnirud snoitidnoc gnitsixe-erp ;)derevoc era snoitacilpmoc( yregrus citemsoc ;sesa ﬁ -eht-no na yb derevoc sselnu ,yrujni ro ssenkcis lanoitapucco ;egarevoc fo shtnom 21 tsrj .redir ytilibasid boW ecnarusnI ytilibasiD etatS ro noitasnepmoC 'srekro - T ton seod etacﬁitrec eh r etats ro noitasnepmoC ’srekroW yna yb egarevoc rof stnemeriuqer eht tceffa ro ecalpe d .ecnarusni ytilibasiPage 39

Page 40

G PLTP BVA A 83831MJBT ecnarusnI efiL 001 egA ot mre F tsom evol uoy esoht rof noitcetorp laicnaniH skroW tI woH s’ere• si tifeneb htaed muminim deetnarauGl sraey 5 rof leve1 • niamer dna elbadroffa era smuimerPl ekam uoy sselnu 001 ega ot levec egarevoc ruoy ot segnah• derevoc eb yam nerdlihC2 • rof thgir s’taht egarevoc eht tceleSy ylimaf ruoy dna uo• ruoy ,yawa ssap uoy fi nehTb mialc a selif yraicifene• tcerid si tifeneb hsac mus-pmul Ad dna deliam si kcehc a ro detisopec hsiw yeht revewoh desu eb naW nac tifeneb htaed eht ,gninnalp hti p morf eerf seiraicifeneb ruoy ot ssa s tlusnoC .sexat etatse laredef ro etat w .scificeps rof rosivda xat ruoy htiP secnaniF ruoY gnitcetorM sdeeN ruoY gniteeT SIHT TUOBA KNIH†2 .ARMIL ,ydutS retemoraB ecnarusnI 020 ††U ,scitsitatS robaL fo uaeruB .S. C .dibi ,yevruS erutidnepxE remusno 1C ot detcejorp si tifeneb htaed deetnaraug-non tnerru r .001 ega ot level niame 2C .setats emos ni tnuoma ecaf s’eeyolpme eht fo egatnecrep a ot detimil eb yam nerdlihc rof egarevo * dna snoisulcxE eht ot refer esaelP L .eruhcorb siht fo noitces noitatimiO no yler sdlohesuoh .S.U fo flah rev d ,ynam rof ,dna ,)%45( semocni lau l eb dluoc emocni eno gniso d secnanif dlohesuoh ot gnitatsave††4 tcapmi laicnanif a leef dluow elpoep fo %4 w s’dlohesuoh rieht gnisol fo shtnom xis nihti p dluow yeht dias %82 .renrae egaw yramir b htnom eno tsuj nihtiw detceffa e† M snaciremA fo %04 naht ero w egarevoc ecnarusni efil hti w rieht desahcrup dah yeht hsi p ega regnuoy a ta seicilo† D .llew sa snoitagilbo laicnanif gnimlehwrevo dniheb evael ot tnaw t’nod uoy – hguone tluciffid si htaed detcepxenu na htiw gnilae W .rehtegot derahs uoy smaerd dna slaog eht lla ezilaer llits nac ylimaf ruoy ,stifeneB etatsllA morf ycilop ecnarusnI efiL mreT a htiPage 40

Page 41

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 41

Page 42

$25,000 $50,000 $75,000 $100,000 $25,000 $50,000 $75,000 $100,00018 $10.83 $21.67 $32.50 $43.33 50 $29.40 $58.79 $88.19 $117.5819 $7.50 $15.00 $22.50 $30.00 51 $32.44 $64.88 $97.31 $129.7520 $7.50 $15.00 $22.50 $30.00 52 $35.50 $71.00 $106.50 $142.0021 $7.50 $15.00 $22.50 $30.00 53 $38.54 $77.08 $115.63 $154.1722 $7.50 $15.00 $22.50 $30.00 54 $41.58 $83.17 $124.75 $166.3323 $7.50 $15.00 $22.50 $30.00 55 $46.88 $93.75 $140.63 $187.5024 $7.50 $15.00 $22.50 $30.00 56 $51.10 $102.21 $153.31 $204.4225 $7.50 $15.00 $22.50 $30.00 57 $55.33 $110.67 $166.00 $221.3326 $7.63 $15.25 $22.88 $30.50 58 $59.56 $119.13 $178.69 $238.2527 $7.75 $15.50 $23.25 $31.00 59 $63.79 $127.58 $191.38 $255.1728 $7.88 $15.75 $23.63 $31.50 60 $67.98 $135.96 $203.94 $271.9229 $8.00 $16.00 $24.00 $32.00 61 $74.52 $149.04 $223.56 $298.0830 $8.13 $16.25 $24.38 $32.50 62 $81.06 $162.13 $243.19 $324.2531 $8.54 $17.08 $25.63 $34.17 63 $87.63 $175.25 $262.88 $350.5032 $8.96 $17.92 $26.88 $35.83 64 $94.17 $188.33 $282.50 $376.6733 $9.38 $18.75 $28.13 $37.50 65 $100.71 $201.42 $302.13 $402.8334 $9.79 $19.58 $29.38 $39.17 66 $110.79 $221.58 $332.38 $443.1735 $10.21 $20.42 $30.63 $40.83 67 $120.85 $241.71 $362.56 $483.4236 $10.65 $21.29 $31.94 $42.58 68 $130.94 $261.88 $392.81 $523.7537 $11.56 $23.13 $34.69 $46.25 69 $141.00 $282.00 $423.00 $564.0038 $12.44 $24.88 $37.31 $49.75 70 $151.06 $302.13 $453.19 $604.2539 $13.31 $26.63 $39.94 $53.25 71 ^ $177.79 $355.58 $533.38 $711.1740 $14.19 $28.38 $42.56 $56.75 72 ^ $184.52 $369.04 $553.56 $738.0841 $15.56 $31.13 $46.69 $62.25 73 ^ $191.79 $383.58 $575.38 $767.1742 $16.92 $33.83 $50.75 $67.67 74 ^ $202.27 $404.54 $606.81 $809.0843 $18.27 $36.54 $54.81 $73.08 75 ^ $214.79 $429.58 $644.38 $859.1744 $19.65 $39.29 $58.94 $78.58 76 ^ $264.88 $529.75 $794.63 $1,059.5045 $21.00 $42.00 $63.00 $84.00 77 ^ $280.85 $561.71 $842.56 $1,123.4246 $22.71 $45.42 $68.13 $90.83 78 ^ $293.77 $587.54 $881.31 $1,175.0847 $24.40 $48.79 $73.19 $97.58 79 ^ $305.29 $610.58 $915.88 $1,221.1748 $26.06 $52.13 $78.19 $104.25 80 ^ $317.50 $635.00 $952.50 $1,270.0049 $27.73 $55.46 $83.19 $110.92° Guarantee Issue (GI) 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. After the first five years, the death benefit may decrease, but it will 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.For Agent Use Only. Not for use with consumer sales. Not to be disseminated to the public.GI° Group Term to Age 100 Life Insurance, Monthly Premium² Quotes For Eligible EMPLOYEES of 1000+ life Employer Groups. GI° Max. $150,000.Monthly Premium forGroup Term to 100 Initial Death Benefit¹ of:Monthly Premium forGroup Term to 100 Initial Death Benefit¹ of:This rate card is for groups sitused in Virginia. This rate card expires and is no longer valid on 12/31/2024.NONTOBACCOIssue AgeThe appropriate Illustration Certification must be completed in all states.Issue AgeFOR HOME OFFICE USE ONLY: Settings were Virginia-Employee-MONTHLY-GI-PREV-1000-TRUE-0-0-N-Initial Death Benefit-25000-50000-75000-100000This rate card is for certificate form GPTLC, or state variation thereof, underwritten by American Heritage Life Insurance Company. Refer to the state specific brochure orpolicy form for exact benefits, limitations, exclusions, and other provisions applicable to the state of solicitation. Allstate Benefits is the marketing name for AmericanHeritage Life Insurance Company, Home Office, Jacksonville, FL, a subsidiary of The Allstate Corporation. ©2024 Allstate Insurance Company. ^ Evidence of insurability (EOI) is required for ages 71-80 and quotes in excess of U/W offer (³).Version 5.2 (Rev. 10/20/22)Printed 8/13/2024 3:50 PMPage 42

Page 43

$25,000 $50,000 $75,000 $100,000 $25,000 $50,000 $75,000 $100,00018 50 $49.10 $98.21 $147.31 $196.4219 $8.33 $16.67 $25.00 $33.33 51 $53.60 $107.21 $160.81 $214.4220 $8.75 $17.50 $26.25 $35.00 52 $57.98 $115.96 $173.94 $231.9221 $9.17 $18.33 $27.50 $36.67 53 $62.52 $125.04 $187.56 $250.0822 $9.58 $19.17 $28.75 $38.33 54 $66.94 $133.88 $200.81 $267.7523 $10.00 $20.00 $30.00 $40.00 55 $70.98 $141.96 $212.94 $283.9224 $10.42 $20.83 $31.25 $41.67 56 $76.69 $153.38 $230.06 $306.7525 $10.83 $21.67 $32.50 $43.33 57 $82.17 $164.33 $246.50 $328.6726 $11.25 $22.50 $33.75 $45.00 58 $87.50 $175.00 $262.50 $350.0027 $11.67 $23.33 $35.00 $46.67 59 $92.98 $185.96 $278.94 $371.9228 $12.08 $24.17 $36.25 $48.33 60 $98.40 $196.79 $295.19 $393.5829 $12.50 $25.00 $37.50 $50.00 61 $106.46 $212.92 $319.38 $425.8330 $12.92 $25.83 $38.75 $51.67 62 $114.42 $228.83 $343.25 $457.6731 $13.33 $26.67 $40.00 $53.33 63 $122.13 $244.25 $366.38 $488.5032 $13.75 $27.50 $41.25 $55.00 64 $129.67 $259.33 $389.00 $518.6733 $14.17 $28.33 $42.50 $56.67 65 $136.73 $273.46 $410.19 $546.9234 $14.58 $29.17 $43.75 $58.33 66 $150.02 $300.04 $450.06 $600.0835 $15.00 $30.00 $45.00 $60.00 67 $163.00 $326.00 $489.00 $652.0036 $16.52 $33.04 $49.56 $66.08 68 $175.67 $351.33 $527.00 $702.6737 $17.98 $35.96 $53.94 $71.92 69 $188.06 $376.13 $564.19 $752.2538 $19.50 $39.00 $58.50 $78.00 70 $200.10 $400.21 $600.31 $800.4239 $21.10 $42.21 $63.31 $84.42 71 ^ $232.77 $465.54 $698.31 $931.0840 $22.60 $45.21 $67.81 $90.42 72 ^ $243.44 $486.88 $730.31 $973.7541 $24.96 $49.92 $74.88 $99.83 73 ^ $255.17 $510.33 $765.50 $1,020.6742 $27.35 $54.71 $82.06 $109.42 74 ^ $268.33 $536.67 $805.00 $1,073.3343 $29.71 $59.42 $89.13 $118.83 75 ^ $283.17 $566.33 $849.50 $1,132.6744 $32.10 $64.21 $96.31 $128.42 76 ^ $300.54 $601.08 $901.63 $1,202.1745 $34.40 $68.79 $103.19 $137.58 77 ^ $311.25 $622.50 $933.75 $1,245.0046 $37.19 $74.38 $111.56 $148.75 78 ^ $322.63 $645.25 $967.88 $1,290.5047 $40.13 $80.25 $120.38 $160.50 79 ^ $334.63 $669.25 $1,003.88 $1,338.5048 $43.15 $86.29 $129.44 $172.58 80 ^ $347.25 $694.50 $1,041.75 $1,389.0049 $46.17 $92.33 $138.50 $184.67° Guarantee Issue (GI) 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. After the first five years, the death benefit may decrease, but it will 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.For Agent Use Only. Not for use with consumer sales. Not to be disseminated to the public.This rate card is for groups sitused in Virginia. This rate card expires and is no longer valid on 12/31/2024.Issue AgeIssue AgeGI° Group Term to Age 100 Life Insurance, Monthly Premium² Quotes The appropriate Illustration Certification must be completed in all states.For Eligible EMPLOYEES of 1000+ life Employer Groups. GI° Max. $150,000.TOBACCOFOR HOME OFFICE USE ONLY: Settings were Virginia-Employee-MONTHLY-GI-PREV-1000-TRUE-0-0-N-Initial Death Benefit-25000-50000-75000-100000Monthly Premium forMonthly Premium forGroup Term to 100 Initial Death Benefit¹ of: Group Term to 100 Initial Death Benefit¹ of:Issue age 18 will always be issued Nontobacco.This rate card is for certificate form GPTLC, or state variation thereof, underwritten by American Heritage Life Insurance Company. Refer to the state specific brochure orpolicy form for exact benefits, limitations, exclusions, and other provisions applicable to the state of solicitation. Allstate Benefits is the marketing name for AmericanHeritage Life Insurance Company, Home Office, Jacksonville, FL, a subsidiary of The Allstate Corporation. ©2024 Allstate Insurance Company. ^ Evidence of insurability (EOI) is required for ages 71-80 and quotes in excess of U/W offer (³).Version 5.2 (Rev. 10/20/22)Printed 8/13/2024 3:50 PMPage 43

Page 44

• latnedicca ,esaesid a morf rehtehw ,eid ll’uoy nehw tciderp t’nac uoY i .sesuac larutan ro yrujn U edivorp nac 001 egA ot mreT ,htaed ruoy nopa yraicifeneb detangised ruoy ot yltcerid tifeneb hsac mus-pmul • efil tnenamrep lanoitidart gnisahcrup dna ,tegdub a no evil uoY i .yltsoc eb dluow ecnarusn T decirp ylbadroffa si 001 egA ot mre• ro 01 ,5 naht erom rof egarevoc sreffo taht ycilop efiL mreT a tnaw uoY 2 .sraey 0 T litnu uoy htiw eb nac taht egarevoc sreffo 001 egA ot mrea 001 eg• ruoy evael uoy dluohs uoy htiw seog taht egarevoc elbadroffa tnaw uoY e .reyolpm Y ees ;uoy htiw egarevoc 001 egA ot mreT eht ekat nac uoy sliated rof ecnarusnI fo etacifitreC ruo• detaler erac htlaeh htiw pleh ot yenom lanoitidda deen yam ylimaf ruoY b .eid uoy retfa slli T tifeneb htaed mus-pmul a sedivorp 001 egA ot mret sesnepxe eseht revoc pleh ot desu eb nac tahG TIFENEB HTAED ECNARUSNI EFIL MRET PUOR G tifeneB htaeD ecnarusnI efiL mreT puor - p detangised ruoy ot tifeneb htaed mus-pmul a sya b etacifitrec eht erofeb eid uoy nehw yraicifene a 001 ega hcaer uoy retfa ro no yrasrevinnO STIFENEB REDIR LANOITIDDA/LANOITP ( )snoitatimil dna snoisulcxe evah sredirA lanimreT rof tifeneB htaeD detarelecc I ssenll -a htaed eht fo %57 fo ecnavda mus-pmul b deifitrec nehw )000,001$ deecxe ot ton( tifene t si elbayap tifeneb ehT .naicisyhp a yb lli yllanimre d .etar tnuocsid tnerruc eht gnisu detnuocsi P tifeneb eht fo tnemyap retfa deviaw era smuimer C mreT s'nerdlih - a a nehw diap si tifeneb htaed c etacifitrec no elbaliava toN .seid dlihc derevo c dlihc a rof desahcrup egarevoG PLTP BVA A 83831MJBB stifeneW uoy rof thgir eb thgim ecnarusnI efiL mreT puorG yhH ?esuops ruoy tsol uoy fi ti eldnah ot ecalp ni secnanif eht evah ton dluow uoy taht deirrow dna tneve gnignahc-efil a decneirepxe reve uoy eva I ,esuops a evah uoy fi ,revewoH .elbaknihtnu eht tuoba kniht ot tnaw ton did uoy esuaceb ffo ti tup uoy tub ,dnim ruoy dessorc evah yam t c :redisnoc ot snosaer lanoitidda emos era ereH .yadot erutuf rieht rof gninnalp tuoba kniht ot hguone nosaer si taht ,nerdlihcdnarg neve ro ,nerdlihP ®.gnivil yadyreve rof stﬁeneB lacitcarW .dnim fo ecaep laicnanif ylimaf ruoy dna uoy evig pleh nac e A .eb nac uoY ®?sdnah doog ni uoy erW elpoep ®sdnaH dooG eht era eW elbaulav ruO .sraey 05 revo rof seilimaf s’aciremA gnitcetorp ,tsurt dna wonk uoy eman eht er’e c dna secnanif rieht rof snoisiced tseb eht ekam ot elpoep rewopme pleh snoitpo egarevot .serutuf riehO rof ,stifeneByM ,latrop ecivres remotsuc tneinevnoc ruo htiw retsiger ,egarevoc detcele ev’uoy ecn a ot uoy swolla osla stifeneByM .stnemucod tnatropmi dna sliated egarevoc ruoy ot ssecca emityn f tnuocca knab ruoy otni yltcerid detisoped stifeneb teg dna – ylisae dna ylkciuq smialc eli ( .)deriuqer noitazirohtua• evah dluow ylimaf ruoy dna renrae egaw yramirp eht er’uoY d .emocni ruoy tuohtiw gnivil ytluciffi I ,001 ega erofeb eid uoy fT mus-pmul a yraicifeneb detangised ruoy sreffo 001 egA ot mred egarevoc fo sraey evif tsrif eht rof deetnaraug si taht tifeneb htaea srotcaf ecneirepxe tnerruc rednu level niamer ot decirp si dn• rac ,egagtrom a sa hcus stbed ylhtnom gnirrucer evah uoY p .sdrac tiderc ro tnemya T mus-pmul a sedivorp 001 egA ot mred sesnepxe ylhtnom revoc pleh ot desu eb nac taht tifeneb htae• yliad rof yenom eriuqer yeht dna ,81 rednu nerdlihc evah uoY l egelloc dna strops loohcs ,gnihtolc ,doof sa hcus sesnepxe gnivie .noitacud T tifeneb htaed mus-pmul a sedivorp 001 egA ot mret sesnepxe gnivil yliad htiw pleh ot desu eb nac tahW esoohc uoy nehA ETATSLL B ,STIFENEw uoy evig pleh nac e a laicnanif ylimaf ruoy dn p .dnim fo ecaePage 44

Page 45

G PLTP BVA A 83831MJBE SNOITATIMIL DNA SNOISULCXS noisulcxE ediciu - I fo etad evitceffe eht fo sraey 2 nihtiw edicius stimmoc nosrep derevoc a f c .nosrep derevoc taht rof diap smuimerp eht ot detimil eb yam tﬁeneb htaed eht ,egarevoO snoitatimiL dna snoisulcxE reht - T snoisulcxe ,sdoirep noitanimile rehto evah sredir dna ycilop eh a .sliated rof etacﬁitrec ruoy ot refer esaelP .egarevoc tceffa yam taht snoitatimil dnT 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 ,PLTPG mrof ycilop rednu dedivorp era stifeneb ecnarusnI efiL mreT puor R ro smrof redir gniwollof eht rednu dedivorp era stifeneb redi s :foereht snoitairav etat A .RTCPLTG mreT s’nerdlihC ;RBLPLTG ssenllI lanimreT rof tifeneB htaeD detareleccT ,eciffO emoH( ynapmoC ecnarusnI efiL egatireH naciremA yb nettirwrednu ycilop yratnulov puorg eht rednu elbaliava stifeneb eht fo weivrevo feirb a si sih J uoy ,noitamrofni lanoitidda roF .deussi setacifitrec eht ni dedulcni era snoisivorp rehto dna ,snoitcirtser ,snoisulcxe gnidulcni ,ecnarusni eht fo sliateD .)LF ,ellivnoskca m .evitatneserpeR stifeneB etatsllA ruoy tcatnoc yaA .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 4202Page 45

Page 46

Halifax County Public Schools ELIGIBILITY All Active Full-Time Employees working 30 hours or more per week, except for any person working on a temporary or seasonal basis. Dependents: You must be insured for your Dependents to be covered. Dependents are:  Your legal spouse who is not legally separated or divorced from you, under age 70 on application date.  Your legally recognized domestic or civil union partner  Your unmarried financially dependent children from birth to 20 years (to 26 years if full-time student).  A person may not have coverage as both an Employee and Dependent.  Only one insured spouse may cover dependent children. BENEFIT AMOUNT Voluntary Life: Choose from a minimum of $10,000 to a maximum of $500,000 in $10,000 increments; subject to a salary cap of 10 times base annual earnings. Spouse: Choose from a minimum of $10,000 to a maximum of $500,000 in $10,000 increments. Child(ren): Birth but less than 6 months: $1,000; 6 months through age 20:A choice of $2,500, $5,000, $7,500, or $10,000 (up to age 26 if a full-time student). PORTING AND CONVERSION OF POLICY Employee: Porting of policy available upon termination if not retiring. Conversion of policy available to retiring employees. TERMINATION OF SPOUSE COVERAGE Spouse: Policy terminates at age 75. RATES PER $10,000 18-39: $0.80 40-59: $1.80 60+: $2.50 Child(ren) per month: $2,500: $0.42 $5,000: $0.82 $7,500: $1.22 $10,000: $1.62 FEATURES Portability Waiver of Premium www.reliancestandard.com This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-8349, et al. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however, a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state. Plan Highlights Voluntary Group Term Life GUARANTEED ISSUE Initial eligibility period only Employee: Under age 60: $200,000 Age 60 but less than age 70: $200,000 Age 70 and over: $200,000 Spouse: Under age 60: $50,000 Age 60+: none Child(ren): $10,000 CONTRIBUTION REQUIREMENTS Coverage is 100% Employee Paid. BENEFIT REDUCTION DUE TO AGE (Applicable to employee) At Age Face Amount Reduces To 75-79 60% of available or in force amount at age 74 80-84 35% of available or in force amount at age 74 85-89 27.5% of available or in force amount at age 74 90-94 20% of available or in force amount at age 74 95-99 7.5% of available or in force amount at age 74 100 + 5% of available or in force amount at age 74 Page 46

2025 Halifax EE Benefits

Page 1

Page 2

Page 3