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EN-2073 FOR EMPLOYEES (8-23) Unum | Group Accident InsuranceCalhoun CountyWho can get coverage? Group Accident InsuranceHow does it work?Accident Insurance provides a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur off the job. And it includes a range of incidents, from common injuries to more serious events.Why is this coverage so valuable?It can help you with out-of-pocket costs that your medical plan doesn’t cover, like co-pays and deductibles. You’ll have base coverage without medical underwriting. The cost is conveniently deducted from your paycheck. You can keep your coverage if you change jobs or retire. You’ll be billed directly.YouIf you’re actively at work*Your spouseCan get coverage as long as you have purchased coverage for yourself.Your childrenDependent children from birth until their 26th birthday, regardless of marital or student status.*Employees must be legally authorized to work in the United States and actively working at a U.S. location to receive coverage. See Schedule of benefits for a complete listing of what is covered. What’s included?Organized Sports BenefitEach family member that has Accident coverage is eligible for a 10% increase in payable benefits within the Injury and Treatment schedule of benefit categories. See disclosures and schedule of benefits for more information.How much does it cost?Your monthly premium Option 1You$7.14You and your spouse$12.79You and your children$20.08Family$25.73

Unum | Group Accident InsuranceEN-2073 FOR EMPLOYEES (8-23)SCHEDULE OF BENEFITSAccidental Death and DismembermentAD&D Employee $25,000Spouse $12,500Children $6,250Common Carrier Benefit can pay if the insured individual is injured as a fare-paying passenger on a common carrier (examples include mass transit trains, buses and planes) Employee $25,000Spouse $12,500Children $6,250Dismemberment Both Feet $25,000Both Hands $25,000One Foot $12,500One Hand $12,500Thumb and Index Finger of the same Hand $6,250Coma Coma $5,000Home & Vehicle Modifications Home & Vehicle Modifications $1,250Loss of Use Hearing (one ear) $6,000Hearing $6,000Sight of one Eye $12,500Sight of both Eyes $25,000Speech $12,500Paralysis Uniplegia $6,250Hemi/Paraplegia $12,500Triplegia $18,750Quadriplegia $25,000HospitalizationAdmission $1,500Admission – Hospital ICU (added to Admission)$1,500Daily Stay (365 days) $200Daily Stay – Hospital ICU (added to Daily Stay)$400Short Stay $200InjuryInjury due to felony & sexual assault$150Organized Sports 10%BurnsInjury2nd Degree Burns - At least 5%, but less than 20% of skin surface$5002nd Degree Burns - 20% or greater of skin surface$1,0003rd Degree Burns - Less than 5% of skin surface$2,0003rd Degree Burns - At least 5%, but less than 20% of skin surface$5,0003rd Degree Burns - 20% or greater of skin surface$10,000ConcussionConcussion $200Connective Tissue DamageOne Connective Tissue (tendon, ligament, rotator cuff, muscle)$90Two or more Connective Tissues (tendon, ligament, rotator cuff, muscle)$150DislocationsKnee joint (other than patella)$1,650Ankle bone or bones of the foot (other than toes)$1,650Hip joint $3,375Collarbone (sternoclavicular)$825Elbow joint $500Hand (other than Fingers) $500Lower Jaw $500Shoulder $500Wrist joint $500Collarbone (acromioclavicular and separation)$325Finger or Toe (Digit) $150Kneecap (patella) $500Incomplete Dislocation - Payable as a % of the applicable Dislocations benefit25%Eye InjuryEye Injury $200FracturesSkull (except bones of Face or Nose), Depressed$4,500Hip or Thigh (femur) $3,375Skull (except bones of Face or Nose), Non-depressed$2,250Vertebrae, body of (other than Vertebral Processes)$1,350Leg (mid to upper tibia or fibula)$1,350Pelvis $1,350InjuryBones of the Face or Nose (other than Lower Jaw, Mandible or Upper Jaw, Maxilla)$675Upper Arm between Elbow and Shoulder (humerus)$675Upper Jaw, Maxilla (other than alveolar process)$675Ankle (lower tibia or fibula)$450Collarbone (clavicle, sternum) or Shoulder Blade (scapula)$450Foot or Heel (other than Toes)$450Forearm (olecranon, radius, or ulna), Hand, or Wrist (other than Fingers)$450Kneecap (patella) $450Lower Jaw, Mandible (other than alveolar process)$450Vertebral Processes $450Rib $450Tailbone (coccyx), Sacrum $450Finger or Toe (Digit) $225Chip Fracture - Payable as a % of the applicable Fractures benefit25%Same bone maximum incurred per accident1 FractureMaximum payable multiplier for multiple bones2 TimesInternal InjuriesInternal Injuries $200LacerationsNo Repair $50Repair Less than 2 inches $150Repair At least 2 inches but less than 6 inches$300Repair 6 inches or greater $600Loss of a DigitOne Digit (other than a Thumb or Big Toe)$750One Digit (a Thumb or Big Toe)$1,125Two or more Digits $1,500Knee CartilageKnee Cartilage (Meniscus) Injury$150Ruptured or Herniated DiscOne Disc $150Two or more Discs $250RecoveryAcquired Brain Injury $25At-Home Care $100Physician Follow-Up Visits $100

Unum | Group Accident InsuranceEN-2073 FOR EMPLOYEES (8-23)SCHEDULE OF BENEFITSRecoveryPhysician Follow-Up Maximum Visits2Prescription Drug $25Prescription Benefit Incidence per covered accident1 Per InsuredRehabilitation or Subacute Rehabilitation Unit$100Behavior Health Therapy $50Behavior Health Therapy visits15Telehealth Service $25Telemedicine Medical Service$25Therapy Services (chiro, speech, PT, occ, acupuncture/alternative)$50Therapy Services Maximum Days10SurgeryDislocationsDislocation, Surgical Repair - Payable as a % of the applicable Injury benefit100%AnesthesiaEpidural or Regional Anesthesia$100General Anesthesia $250Connective TissueExploratory without Repair $100Repair for One Connective Tissue$800Repair for Two or more Connective Tissues$1,200Eye SurgeryEye Surgery, Requiring Anesthesia$300FracturesFractures, Surgical Repair - Payable as a % of the applicable Injury benefit100%Surgical Repair same bone maximum incurred per accident1 FractureSurgical Repair same bone maximum payable multiplier for multiple bones2 TimesGeneral SurgeryAbdominal, Thoracic, or Cranial$1,500Exploratory $150Incidence per covered accident1 Per InsuredHernia SurgeryHernia Surgery $150Knee CartilageSurgeryKnee Cartilage (Meniscus) Exploratory without Repair$150Knee Cartilage (Meniscus) with Repair$750Outpatient Surgical FacilityOutpatient Surgical Facility$300Ruptured or Herniated Disc SurgeryExploratory without Repair $125One Disc $675Two or more Discs $1,000TreatmentOrganized Sports 10%AmbulanceAir $1,000Ground $200Durable Medical EquipmentTier 1 (arm sling, cane, medical ring cushion)$50Tier 2 (bedside commode, cold therapy system, crutches)$100Tier 3 (back brace, body jacket, continuous passive movement, electric scooter)$200Emergency Dental RepairDental Crown $350Dental Extraction $115Filling or Chip Repair $90ImagingTier 1: X-rays or Ultrasound$50Tier 2: Bone Scan, CAT, CT, EEG, MR, MRA, or MRI$200Medical Imaging Incidence allowance covered accident per Tier1 Per Insured Per TierLodgingLodging (per night) $150Prosthetic DeviceOne Device or Limb $750Two or more Devices or Limbs$1,500Skin GraftsFor Burns - Payable as a % of the applicable Burn benefit50%Not Burns - Less than 20% of skin surface$250Not Burns - 20% or greater of skin surface$500TreatmentEmergency Room Treatment $100TreatmentInjections to Prevent or Limit Infection (tetanus, rabies, antivenom, immune globulin)$50Pain Management Injections (epidural, cortisone, steroid)$100Transfusions $400Transportation (per trip) $100Family Care $50Pet Boarding (per day) $30Treatment in a Physician’s Office or Urgent Care Facility (initial)$75•

EN-2073 FOR EMPLOYEES (8-23)Unum | Group Accident InsuranceOrganized Sports BenefitThis increased benefit payment will be applied if the covered Accident occurs while playing an organized sport that required formal registration to participate and is officiated by someone certified to act in that capacity. Active employmentYou are considered in active employment if, on the day you apply for coverage, you are being paid regularly for the required minimum 30 hours each week and you are performing the material and substantial duties of your regular occupation. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. New employees have a 30 day waiting period to be eligible for coverage. Please contact your plan administrator to confirm your eligibility date. If enrolling, and eligible for Medicare (age 65+; or disabled) the Guide to Health Insurance for People with Medicare is available at https://www.medicare.gov/publications/02110-medigap-guide-health-insurance.pdfEffective date of coverageCoverage becomes effective on the first day of the month in which payroll deductions begin.Exclusions and limitations We will not pay benefits for a claim that is caused by, contributed to by, or occurs as the result any of the following:• committing or attempting to commit a felony;• being engaged in an illegal occupation or activity;• injuring oneself intentionally or attempting or committing suicide, whether sane or not;• active participation in a riot, insurrection, or terrorist activity. This does not include civil commotion or disorder, Injury as an innocent bystander, or Injury for self-defense;• participating in war or any act of war, whether declared or undeclared;• combat or training for combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations;• a Covered Loss that occurs while an Insured is legally incarcerated in a penal or correctional institution;• elective procedures, cosmetic surgery, or reconstructive surgery unless it is a result of trauma, infection, or other diseases;• an occupational injury; • any Sickness, bodily infirmity, or other abnormal physical condition or Mental or Nervous Disorders, including diagnosis, treatment, or surgery for it;• Infection. This exclusion does not apply when the infection is due directly to a cut or wound sustained in a Covered Accident;• experimental or investigational procedures;• operating any motorized vehicle while intoxicated;• operating, learning to operate, serving as a crew member of any aircraft or hot air balloon, including those which are not motor-driven, unless flying as a fare paying passenger;• jumping, parachuting, or falling from any aircraft or hot air balloon, including those which are not motor-driven;• travel or flight in any aircraft or hot air balloon, including those which are not motor-driven, if it is being used for testing or experimental purposes, used by or for any military authority, or used for travel beyond the earth’s atmosphere;#practicing for or participating in any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received;• riding or driving an air, land or water vehicle in a race, speed or endurance contest; and• engaging in hang-gliding, bungee jumping, sail gliding, parasailing, parakiting, or BASE jumping.The Accidental Death and Dismemberment Benefits are also subject to the following Exclusions. We will not pay benefits for a claim that is caused by, contributed to by, or resulting from any of the following:• being intoxicated; and• voluntary use of or treatment for voluntary use of any prescription or non-prescription drug, intoxicant, poison, fume, or other chemical substance unless taken as prescribed or directed by the Insured’s PhysicianAdditionally, no benefits will be paid for a Covered Loss that occurs prior to the Coverage Effective Date.End of CoverageIf you choose to cancel your coverage your coverage ends on the first of the month following the date you provide notification to your employer. Otherwise, your coverage ends on the earliest of the:• the date this policy is canceled by Unum or your employer;• the date you are no longer in an eligible group;• the date your eligible group is no longer covered;• the date of your death;• the last day of the period any required premium contributions are made;• the last day you are in active employment. However, as long as premium is paid as required, coverage will continue• in accordance with the Continuation of your Coverage during Absences provision; or• if you elect to continue coverage for you, your Spouse, and Children under Portability of Accident Insurance. We will provide coverage for a Payable Claim that occurs while you are covered under this certificateTHIS IS A LIMITED BENEFITS POLICYThis coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this coverage.This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to certificate form GAC16-1 et al. and GAC16-2 and Policy Form GAP16-1 et al. in all states or contact your Unum representative.Unum complies with state civil union and domestic partner laws when applicable.Underwritten by: Unum Insurance Company, Portland, Maine© 2023 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.