Visicor Generic Benefit Guide : simplebooklet.com

EN-2026 FOR EMPLOYEES (2-23) Unum | Dental InsuranceCovered Procedures & Waiting PeriodsPassive PPOCLASS A PREVENTIVE SERVICESWaiting Period: None • Routine exams (2 per 12 months) • Prophylaxis (2 per 12 months) – (1 additional cleaning or periodontal maintenance per 12 months, if member is in 2nd or 3rd trimester of pregnancy) • Bitewing x-rays (maximum of 4 films; 1 per 12 months) • Fluoride treatment for children up to age 16 (1 per 12 months) • Sealants for children up to age 16 (permanent molars, 1 per 36 months) • Space Maintainers • Full mouth/panoramic x-rays (1 per 36 months) • Adjunctive pre-diagnostic oral cancer screening (1 per 12 months for ages 40+)CLASS B BASIC SERVICESWaiting Period: None • Emergency Treatment (1 per 12 months) • Simple restorative services (fillings) – Posterior composite restorations • Simple extractions • Oral Surgery (extractions and impacted teeth) • Anesthesia (subject to review, covered with complex oral surgery) • Non-Surgical periodontics • Surgical periodontics (gum treatments) • Periodontal maintenance (2 per 12 month in combination with prophylaxis) • Endodontics (root canals)CLASS C MAJOR SERVICESWaiting Period: None • Repair of crown, denture or bridge • Inlays and onlays • Crowns, bridges, dentures and implantsCLASS D ORTHODONTICSWaiting Period: None • Separate Lifetime Maximum: $1,500 • Up to 25% of lifetime allowance may be payable on initial banding • Dependent children to age 19 onlyRefer to your certificate of coverage for the services covered under your plan.

Page 3

Exclusions and LimitationsThe following dental services are not covered unless stated otherwise in the Certificate of Coverage:• any treatment which is elective or primarily cosmetic in nature and not generally recognized as a generally accepted dental practice by the American Dental Association, as well as any replacement of prior elective or cosmetic restorations;• replacement of a removable device or appliance that is lost, missing or stolen, and for the replacement of removable appliances that have been damaged due to abuse, misuse, or neglect. This may include but not be limited to removable partial dentures or dentures;• replacement of any permanent or removeable device or appliance unless the device or appliance is no longer functional and is older than the limitation in the Schedule of Covered Procedures. This may include but not be limited to bridges, dentures and crowns;• any appliance, service, or procedure performed for the purpose of splinting, to alter vertical dimension or to restore occlusion;• any appliance, service or procedure performed for the purpose of correcting attrition, abrasion, erosion, abfraction, bite registration, or bite analysis;• charges for implants (except noted above), removal of implants, precision or semi-precision attachments, denture duplication, or dentures and any associated surgery, or other customized services or attachments;• services provided for any type of temporomandibular joint (TMJ) dysfunction, muscular, skeletal deficiencies involving TMJ or related structures, myofascial pain.Limitations:• Multiple restorations on one surface are payable as one surface. Multiple surfaces on a single tooth will not be paid as separate restorations. On any given day, more than 8 periapical x-rays or a panoramic film in conjunction with bitewings will be paid as a full mouth radiograph. Pre-estimates are recommended for any treatment expected to exceed $300.Takeover benefits:Takeover benefits apply if we are taking over a comparable benefits plan from another carrier and only if there is no break in coverage between the original plan and the takeover date. Takeover is available to those individuals insured under the employer’s dental plan in effect at the time of the employer’s application. If takeover benefits are included in your benefits, then waiting periods for service will be waived for the individuals currently insured under the employer’s previous plan during the month prior to coverage moving to us. Application of takeover benefits is subject to Underwriting review and approval. New hires with prior-like dental coverage (lapse in coverage must be less than 63 days) will receive takeover credit for the length of time they had with the prior carrier and must provide proof of coverage (including coverage dates) to receive takeover credit (i.e. one page benefit summary, Certificate of Creditable Coverage, etc.). A Network Access plan is available. THIS POLICY PROVIDES LIMITED BENEFITS This brochure is not intended to be a complete description of the insurance coverage available. The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form Series Dental 20-GDN or contact your Unum Dental representative. Underwritten by Starmount Life Insurance Company, Baton Rouge, LA.© 2023 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. EN-2026 FOR EMPLOYEES (2-23)unum.com

Page 4

XYZ Brokerage FirmEffective date: 12/01/2019 Plan features: - Our network offers members access toconvenient, quality care with more than 40,000vision access points1, including independentoptometrists and retail stores like Walmart,Sam’s Club, JCPenney, Sear’s Optical, America’sBest and many more!- Find an in-network provider atunumvisioncare.com- Manage benefits online with AlwaysAssist.comand on-the-go with the AlwaysAssist mobile app.Monthly Premium Rates2: Rates are guaranteed 12/01/2019 to 12/01/2023 with 54% participation Employee Only $7.56 Employee & Spouse $14.27 Employee & Child(ren) $15.56 Employee & Family $20.02 Covered benefits: Exam: Each member is entitled to a comprehensive vision exam. An exam co-pay applies and is outlined in the grid below. Materials: Each member may purchase eyewear in the form of an eyeglass frame and lenses, or contact lenses. Purchases are subject to benefit frequencies and co-pays. Plan features include: • Frame benefit: You may choose any frame within a provider’s collection,subject to the retail frame allowance listed below. If the cost is greaterthan the plan’s benefits, you are responsible for the difference.• Eyeglass lens benefit: Standard plastic (CR-39 Plastic Material) singlevision, bifocal and trifocal lenses are generally covered after anyapplicable materials copay. Plan allowances are listed below for specialtylenses. If the cost is greater than the plan’s benefits, you are responsiblefor the difference.• Contact lens benefit: Members electing contact lenses instead of glassesmay apply the contact lens allowance to any lenses in the provider’scollection. If the cost is greater than the plan’s benefits, you areresponsible for the difference. The contact allowance will apply to theretail cost of contact lenses and to any professional fitting fee charged bythe provider. Some providers, operating independently of the opticalstore, may charge separately for the fit and evaluation, permitting thecontact lens benefit to be used fully for materials.Laser vision correction: Discounts are available with participating surgery providers across the country (not an insured benefit)Overview:Vision Care Services All Participating Providers Out-of-Network Exam (1 per 12 month) $10 Co-pay Up to $35 Materials $10 Co-pay See Below Standard Plastic Lenses: (1 per 12 month) Single Vision Bifocal Trifocal Lenticular Progressive Lens Options: Scratch resistant coating Polycarbonate Lenses for children to age 19 Covered by Co-pay Covered by Co-pay Covered by Co-pay $80 allowance $70 allowance Covered at Wal-Mart only Covered Up to $25 Up to $40 Up to $50 Up to $50 Up to $40 Not Covered Not Covered Frames: (1 per 24 months) Members choose from any frame available at provider locations. Up to $150 allowance Up to $50 retail Contact Lenses3: (1 per 12 months) (Includes fit4, follow-up and materials) Elective Medically Necessary $10 Co-pay Up to $150 allowance Up to $210 allowance Up to $100 Up to $210 1. Starmount internal data,2017. Access points are sites where network providers see patients. Some providers may be available at more than oneaccess point.2. Final rates subject to home office underwriting verificationof participation and other factors. Members must enrollfor a minimum of 12 months.3. Contact lenses are in lieu ofeyeglass lenses and frames.4. Some providers, such as Walmart, may charge for a contact lens fit and evaluationseparately from your contact lens allowance, leaving the entire allowance for materials.11

Page 5

This brochure is not intended to be a complete description of the insurance coverage available. The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form Series Vision – VI-2002 and VI-2007 or contact your Unum VisionSM representative. Starmount Life Insurance Company 8485 Goodwood Boulevard • Baton Rouge, LA 70806 PH: (888) 400-9304 Policy Forms: Vision – VI-2002 and VI-2007 (08-18) Vision plans are marketed by Unum, administered and underwritten by Starmount Life Insurance Company, Baton Rouge, LA. ©2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. Other Unum Vision specifications Dependent children: Dependent age guidelines vary by state. Please refer to your policy certificate or contact customer service at 888-400-9304. Services not listed: If you expect to require a vision service not included on this brochure, it may still be covered. Please contact customer service at 888-400-9304, to confirm your exact benefits.This is a primary vision care benefit and is intended to cover only eye examinations and corrective eyewear. Medical or surgical treatment of eye disease or injury is not provided under this plan. Coverage may not exceed the lesser of actual cost of covered services and materials or the limits of the policy. Some providers at optical and/or retail chains, such as Walmart, may charge for a contact lens fit and evaluation separately and apart from your contact lens allowance, leaving the entire allowance for materials. Covered materials that are lost or broken will be replaced only at normal service intervals indicated in the Plan Design; however, these materials and any items not covered below may be purchased at Preferred Pricing from a Participating Provider. In addition, benefits are payable only for expenses incurred while the Group and individual Member coverage is in force. This plan will not cover: Orthoptics or vision training and any supplemental testing; Plano (non- prescription) lenses; or two pair of eyeglasses in lieu of bifocals or trifocals; Medical or surgical treatment of the eyes; An eye exam or corrective eye wear required by an employer as a condition of employment; Any injury or illness covered under Workers’ Compensation or similar law, or which is work related; Plain or prescription sunglasses or tinted lenses, and no-line bifocals and blended lenses (subject to allowance); Sub-normal vision aids; Services rendered or materials purchased outside the U.S. or Canada, unless: the insured resides in the U.S. or Canada, and the charges are incurred while on a business or pleasure trip; Charges in excess of Usual and Customary for services and materials; Experimental or non-conventional treatments or devices; Safety eyewear; Spectacle lens styles, materials, treatments or “add-ons” not shown in the Schedule of Benefits. Laser vision correction network Membership provides access to preferred pricing. Transactions are handled directly between members and providers. Refractive surgery is an elective procedure and may involve potential risks to patients. This is not an insured benefit. Unum cannot and does not guarantee the outcome of any refractive surgical procedure or a total elimination of the need for glasses or contacts. Providers may not be available in all metropolitan areas. Login to www.alwaysassist.com for a list of participating laser vision correction providers. Semi-Monthly Rates EE: $3.78ES: $7.14EC: $7.78EF: $10.0112

Page 6

Ratesfortheselinesareloadedintheonlineenrollmentplatformandexplainedinmoredetailonthefollowingpages.EmployerPaidLifeInsuranceToensurethatyouhaveadequatecoverageforyourfamily’sfinancialneeds,____ ____provides______________ofBasicLifeInsurancecoverageforalleligiblefull-timeemployees.VoluntaryGroupTermLife/AD&DVoluntaryGroupTermLifeInsuranceisalsoavailableforyou,yourspouse,andyourdependentchildrenthrough_________________.Asanemployee,youmaypurchaseTermLifeInsuranceforyourselfinbenefitamountsbetween$10,000and_____________,in$10,000increments.GuaranteedIssuedYoucanpurchaseupto______________withouthavingtoansweramedicalquestionnaire.Ifyouchoosenottoenrollwhenyouarefirstofferedtheopportunityandchoosetoenrollatalatertime,youwillhavetocompleteamedicalquestionnaireandaresubjecttothecarrier’sapproval/denial.CriticalIllnesswithCancerCoverageEverydaythousandsofpeoplearediagnosedwithaseriousillness,suchascancerorarestrickenwithaheartattack,stroke,orotherunexpectedmedicalconditions.Thecostsassociatedwithseriousillnesses–evenforindividualswithmedicalinsurance–canbeastronomical.Thisplancanhelpovercomesomeofthecostsrelatedtosuddenillnessesthatarenotcoveredbymedicalinsurance.Youmayalsopurchasecoverageonyourspouse(age18–70)andyourdependentchildren(undertheageof26,whoareunmarriedandyourdependent.Diagnosishastotakeplaceafterthepolicyeffectivedate.UpondiagnosisofacoveredCriticalIllness,thecoveredindividualwillreceive100%ofthelumpsumbenefitamountelected.     Ratesfortheseplansareloadedintheonlineenrollmentplatformandexplainedinmoredetailonthefollowingpages.AccidentInsuranceAccidentsareunexpected,asarethevariousexpenditures associated withthem.Whilemosthealthinsurancecoversmajorexpenses,itdoesnot covereveryrelatedcost.Youcouldface office visitcopays,deductibles,andtransportation/lodgingcosts – all costyou weren’t expecting. The AccidentInsurancegivesyoutheprotectionfortheunexpected.Theplanpaysyouabenefitthat can beappliedtoexpendituressurroundinganaccident,includingbutnotlimitedtoambulance,emergencyroom treatment,doctor’svisits,andsurgeryrelatedtotheaccident.Italsopaysbenefitsforcommonaccidentalinjuries,suchasburns,concussions,emergencydentalwork,dislocations,fractures,andmuchmore.Theamountofbenefityoureceive dependsonthenatureoftheinjuryorthetypeofserviceyoureceive. And thesebenefitsarepaidinadditiontoanymedicalinsuranceyoumighthave.ShortTerm/LongTerm DisabilityInsuranceHowdoyouseeyourselffiveyearsfromnow? Or ten?Chances are,you don’t seeyourself disabled. Butasurprisingnumberofpeopledofindthemselvesinjuredorsickandunabletowork – even if onlyforashorttime.Butwouldamonthseemlikeashorttimeifyouhadnoincome?Youremployeroffers plans thatwillhelpyoupayforyourhousehold expensesifyoubecome disabled andcannotwork.Theseplansmaybepurchasedwithout answeringhealthquestionsaslongasyouenrollwhenyouarefirsthired orthefirstyeartheplanisoffered.Enrollmentatanyothertimewill require medicalevidenceofinsurability._XYZ Company$25,000UNUM$500,000$100,00013

Page 7

EN-2046 (9-18) FOR EMPLOYEES1 Unum internal data, 2017.XYZ Brokerage FirmTerm Life with Accidental Death & Dismemberment (AD&D) Insurance can provide money for your family if you die or are diagnosed with a terminal illness.How does it work?You keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, ﬁnal arrangements, tuition and more.AD&D Insurance is also available, which can pay a beneﬁt if you survive an accident but have certain serious injuries. It can pay an additional amount if you die from a covered accident.Why choose Unum?Your employer is offering you this coverage at no cost to you. Unum is the leading provider of employee beneﬁts, with more than 165 years of experience.1 We’ll be there to back our beneﬁts and provide you with the support you need.Who can get Term Life coverage?If you are actively at work at least 30 hours per week, you can receive coverage for:You You can receive a benefit amount of $25,000.Who can get Accidental Death & Dismemberment (AD&D) coverage?You You can receive an AD&D benefit amount of $25,000.No questions or health exams required for AD&D coverage.What else is included? A “Living” Beneﬁt If you are diagnosed with a terminal illness with less than 12 months to live, you can request 75% of your life insurance beneﬁt (up to $500,000) while you are still living. This amount will be taken out of the death beneﬁt and may be taxable. Waiver of premium Your cost may be waived if you are totally disabled for a period of time.Portability You may be able to keep coverage if you leave the company, retire or change the number of hours you work.Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability.14

Page 8

EN-2046 (9-18) FOR EMPLOYEESExclusions and limitationsActively at workEligible employees must be actively at work to apply for coverage. Being actively at work means on the day the employee applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the employee will be considered actively at work as of his/her last scheduled workday. Employees are not considered actively at work if they are on a leave of absence or lay off.Employees must be U.S. citizens or legally authorized to work in the U.S. to receive coverage.Employees must be actively employed in the United States with the Employer to receive coverage. Employees must be insured under the plan for spouses and dependents to be eligible for coverage.Exclusions and limitationsLife insurance benefits will not be paid for deaths caused by suicide occurring within 24 months after the effective date of coverage. The same applies for increased or additional benefits.AD&D specific exclusions and limitations:Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from:• Disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)• Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane• War, declared or undeclared, or any act of war• Active participation in a riot• Committing or attempting to commit a crime under state or federal law• The voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your doctor. This exclusion does not apply to you if the chemical substance is ethanol.• Intoxication – “Being intoxicated” means your blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.Delayed effective date of coverage Employee: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.Age reductionCoverage amounts for Life and AD&D Insurance for you will reduce to 65% of the original amount when you reach age 65, and will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction.Termination of coverageYour coverage under the policy ends on the earliest of:• The date the policy or plan is cancelled• The date you no longer are in an eligible group• The date your eligible group is no longer covered• The last day of the period for which you made any required contributions• The last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverageThis 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 Policy Form C.FP-1 et al or contact your Unum representative.Life Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.Underwritten by:Unum Life Insurance Company of America, Portland, Maine© 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.Term Life Insurance with Accidental Death & Dismemberment (AD&D)15

Page 9

EN-1976 (10-18) FOR EMPLOYEESXYZ Brokerage FirmTerm Life and Accidental Death & Dismemberment (AD&D) Insurance can provide money for your family if you die or are diagnosed with a terminal illness.How does it work?You choose the amount of coverage that’s right for you, and you keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, ﬁnal arrangements, tuition and more.AD&D Insurance is also available, which pays a beneﬁt if you survive an accident but have certain serious injuries. It pays an additional amount if you die from a covered accident.Why is this coverage so valuable?If you buy a minimum of $10,000 of coverage now, you can increase your coverage in the future up to $100,000 to meet your growing needs. You won’t have to answer any health questions or take a health exam.Who can get Term Life coverage?If you are actively at work at least 30 hours per week, you may apply for coverage for:You Choose from $10,000 to $500,000 in $10,000 increments, up to 5 times your earnings.You can get up to $100,000 with no health questions. This is your guaranteed issue amount.Your SpouseGet up to $100,000 of coverage in $5,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself.Your spouse can get up to $30,000 with no health questions, if eligible (see delayed effective date). This is their guaranteed issue amount.Your ChildrenGet up to $10,000 of coverage in $2,000 increments if eligible (see delayed effective date). One policy covers all of your children until their 26th birthday.The maximum beneﬁt for children live birth to 6 months is $1,000.What else is included? A “Living” Beneﬁt If you are diagnosed with a terminal illness with less than 12 months to live, you can request 75% of your life insurance beneﬁt (up to $500,000) while you are still living. This amount will be taken out of the death beneﬁt. These beneﬁt payments may adversely affect the recipient’s eligibility for Medicaid or other government beneﬁts or entitlement, and may be taxable. Recipients should consult their tax attorney or advisor before utilizing living beneﬁt payments.Waiver of premium Your cost may be waived if you are totally disabled for a period of time.Portability You may be able to keep coverage if you leave the company, retire or change the number of hours you work.Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability.Who can get Term Life coverage?If you are actively at work at least 30 hours per week, you may apply for coverage for:You Choose from $10,000 to $500,000 in $10,000 increments, up to 5 times your earnings.You can get up to $100,000 with no health questions. This is your guaranteed issue amount.Your SpouseGet up to $100,000 of coverage in $5,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself.Your spouse can get up to $30,000 with no health questions, if eligible (see delayed effective date). This is their guaranteed issue amount.Your ChildrenGet up to $10,000 of coverage in $2,000 increments if eligible (see delayed effective date). One policy covers all of your children until their 26th birthday.The maximum beneﬁt for children live birth to 6 months is $1,000.Who can get Accidental Death & Dismemberment (AD&D) coverage?You: Get up to $500,000 of AD&D coverage for yourself in $10,000 increments to a maximum of 5 times your earnings.Your Spouse:Get up to $100,000 of AD&D coverage for your spouse in $5,000 increments, if eligible (see delayed effective date).Your Children:Get up to $10,000 of coverage for your children in $2,000 increments if eligible (see delayed effective date).No questions or health exams required for AD&D coverage. Delayed Effective Date: If your spouse or child has a serious injury, sickness, or disorder, or is confined, their coverage may not take effect. Payment of premium does not guarantee coverage. Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan.16

Page 10

EN-1976 (10-18) FOR EMPLOYEESTerm Life and Accidental Death & Dismemberment (AD&D) InsuranceHow much coverage can I get?1. Enter the coverageamount you want.2. Divide by the amountshown.3. Multiply by the rate.Use the rate table (atright) to find the ratebased on age.(Choose the age you willbe when your coveragebecomes effective on12/01/2019. To determineyour spouse rate, choose theage the spouse will be whencoverage becomes effectiveon 12/01/2019.)4. Enter your cost.Billed amount may vary slightly.If you apply for coverage above the guaranteed issue amount, you will be asked health-related questions which may affect your ability to get the larger coverage amount. In order to purchase coverage for your dependents, you must buy coverage for yourself. Coverage amounts cannot exceed 100% of your coverage amounts. Calculate your costs1 2 3 4Employee $______,000 ÷ $10,000 = $________ X $______ = $_______Spouse $______,000 ÷ $5,000 = $________ X $______ = $_______Child $______,000 ÷ $2,000 = $________ X $______ = $_______Total costSpouse monthly ratePer $5,000 of coverageCost$0.400$0.400$0.350$0.525$0.900$1.500$2.300$3.500$4.800$9.000$22.900$22.900Employee monthly rateAgePer $10,000 of coverageCost15-24 $0.49525-29 $0.58230-34 $0.82535-39 $1.26140-44 $1.91145-49 $2.40050-54 $3.90055-59 $6.10160-64 $7.73165-69 $11.06870-74 $20.93375+ $64.699Child monthly rate$0.400 per $2,000 of coverage1. Enter the AD&Dcoverage amountyou want.2. Divide by the amountshown.3. Multiply by the rate.Use the AD&D ratetable (at right) to findthe rate.4. Enter your cost.AD&D monthly ratesCoverage amount RateEmployee per $10,000 of coverage $0.200Spouse per $15,000 of coverage $0.100Child per $2,000 of coverage $0.095AD&D1 2 3 4Employee $______,000 ÷ $10,000 = $________ X $0.200 = $_______Spouse $______,000 ÷ $15,000 = $________ X $0.100 = $_______Child $______,000 ÷ $2,000 = $________ X $0.095 = $_______Total cost17

Page 11

EN-1976 (10-18) FOR EMPLOYEESExclusions and limitationsActively at workEligible employees must be actively at work to apply for coverage. Being actively at work means on the day the employee applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the employee will be considered actively at work as of his/her last scheduled workday. Employees are not considered actively at work if they are on a leave of absence or lay off.An unmarried handicapped dependent child who becomes handicapped prior to the child’s attainment age of 26 may be eligible for benefits. Please see your plan administrator for details on eligibility.Employees must be U.S. citizens or legally authorized to work in the U.S. to receive coverage. Spouses and dependents must live in the U.S. to receive coverage.Employees must be actively employed in the United States with the Employer to receive coverage. Employees must be insured under the plan for spouses and dependents to be eligible for coverage.Exclusions and limitationsLife insurance benefits will not be paid for deaths caused by suicide occurring within 24 months after the effective date of coverage. The same applies for increased or additional benefits. AD&D specific exclusions and limitations:Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from:• Disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)• Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane• War, declared or undeclared, or any act of war• Active participation in a riot• Committing or attempting to commit a crime under state or federal law• The voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol.• Intoxication – “Being intoxicated” means your or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.Delayed effective date of coverage Insurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.Delayed Effective Date: If your spouse or child has a serious injury, sickness, or disorder, or is confined, their coverage may not take effect. Payment of premium does not guarantee coverage. Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan.Age reductionCoverage amounts for Life and AD&D Insurance for you and your dependents will reduce to 65% of the original amount when you reach age 65, and will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction.Termination of coverageYour coverage and your dependents’ coverage under the policy ends on the earliest of:• The date the policy or plan is cancelled• The date you no longer are in an eligible group• The date your eligible group is no longer covered• The last day of the period for which you made any required contributions• The last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverageIn addition, coverage for any one dependent will end on the earliest of:• The date your coverage under a plan ends• The date your dependent ceases to be an eligible dependent• For a spouse, the date of a divorce or annulment• For dependents, the date of your deathUnum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.This information is not intended to be a complete description of the insurance coverage Term Life and Accidental Death & Dismemberment (AD&D) Insuranceavailable. 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 Policy Form C.FP-1 et al or contact your Unum representative.Life Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.Unum complies with state civil union and domestic partner laws when applicable.Underwritten by:Unum Life Insurance Company of America, Portland, Maine© 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.18

Page 12

Page 13

EN-1977 (6-20) FOR EMPLOYEESXYZ Brokerage FirmShort Term Disability Insurance can pay you a weekly beneﬁt if you have a covered disability that keeps you from working.How does it work?If a covered illness or injury keeps you from working, Short Term Disability Insurance can replace part of your income while you recover. As long as you remain disabled, you can receive payments for up to 13 weeks. You’re generally considered disabled if you’re unable to do important parts of your job — and your income suffers as a result. Why is this coverage so valuable?You can use the money however you choose. It can help you pay for your rent or mortgage, groceries, out-of-pocket medical expenses and more.What’s covered? This insurance may cover a variety of conditions and injuries. Here are Unum’s top reasons for short term disability claims:1 •Normal pregnancy•Injuries (excluding back)•Joint disorders•Cancer•Digestive disordersThis plan does not cover pre-existing conditions. Seethe disclosure section to learn more.1 Unum internal data, 2018. Note: Causes are listed in ranked order.Consider your weekly expensesFood $_______Transportation _______ (gas, car payments, repairs)Child care/elder care _______Mortgage/rent _______Utilities _______ (electric, water, cable, phone)Medical costs _______ (co-pays, medications)Insurance _______ (health, life, car, home)Total weekly expenses $_______19

Page 14

EN-1977 (6-20) FOR EMPLOYEESShort Term Disability InsuranceHow much coverage can I get?! Coverage is guaranteed as long as a certain number of employeespurchase coverage. If you don’t sign up now but decide to applylater, you may have to answer medical questions.Elimination period (EP)This is the number of days that must pass between your first day of a covered disability and the day you can begin to receive your disability benefits.Your benefits would begin after 0 days if you become disabled due to an injury and 7 days if you become disabled due to an illness.Benefit duration (BD)The maximum number of weeks you can receive benefits while you’re disabled. You have a 13 week benefit duration.Calculate your costYou*You are eligible for coverage if you are an active employee in the United States working a minimum of 30 hours per week.Coverage amounts Cover 60% of your weekly income, up to a maximum benefit of $1,000 per week. The weekly benefit may be reduced or offset by other sources of income. *See the Legal Disclosures for more information• For step 2:Enter your rate from theRate Chart, based on yourage.(Choose the age you will bewhen your coverage becomeseffective on 12/01/2021.)Billed amount may vary slightly. Your rate is based on your age and will increase as you move to the next age band. * The maximum covered annual income is $86,666.Age Rates15-24 $0.78025-29 $1.04030-34 $0.50135-39 $0.30640-44 $0.21545-49 $0.25450-54 $0.33255-59 $0.39760-64 $0.48165+ $0.585Disability worksheet1Calculate your weekly disability benefit.$________ ÷ 52 = $________ x 60% =$__________Max weekly benefit available (if the amount exceeds the plan max of $1,000, enter $1,000.Your annualearningsYour weeklyearnings(Max % ofincome covered)2Calculate your cost per paycheck.$________÷ 10 = $________ x $_______ =$________ x 12 = $_______ ÷ ________ =$__________Your weeklybenefit amountYour rate Your monthly costYour annual costNumber of paychecks per yearYour cost per paycheck20

Page 15

EN-1977 (6-20) FOR EMPLOYEESExclusions and limitationsActive employeeYou are considered in active employment, if on the day you apply for coverage, you are being paid regularly by Glass Sorenson and McDavid for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation.Delayed effective date of coverageInsurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.Definition of disabilityYou are considered disabled when Unum determines that, due to sickness or injury:• You are limited from performing the material and substantial duties of your regular occupation and you are not working; or• You are working but you have lost 20% or more in weekly earnings.You must be under the regular care of a physician in order to be considered disabled. The loss of a professional or occupational license or certification does not, in itself, constitute disability. Unless the policy specifies otherwise, as part of the disability claims evaluation process, Unum will evaluate your occupation based on how it is normally performed in the national economy, not how work is performed for a specific employer, at a specific location or in a specific region.Pre-existing conditionsYou have a pre-existing condition if: • You received medical treatment, consultation, care or services including diagnostic measures for the condition, or took prescribed drugs or medicines for it in the 3 months just prior to your effective date of coverage; and• The disability begins in the first 12 months after your effective date of coverage. Deductible sources of incomeYour disability benefit may be reduced by deductible sources of income and any earnings you have while you are disabled, including such items as group disability benefits or other amounts you receive or are entitled to receive:• Workers’ compensation or similar occupational benefit laws• State compulsory benefit laws• Automobile liability insurance policy• Motor vehicle insurance policy or plan• No fault motor vehicle plan• Legal judgments and settlements• Salary continuation or sick leave plans, if applicable• Other group or association disability programs or insurance• Social Security or similar governmental programsExclusions and limitationsBenefits will not be paid for disabilities caused by, contributed to by, or resulting from:• War, declared or undeclared or any act of war• Active participation in a riot• Intentionally self-inflicted injuries;• Loss of professional license, occupational license or certification;• Commission of a crime for which you have been convicted;• Any period of disability during which you are incarcerated;• Any occupational injury or sickness (this will not apply to a partner or sole proprietor who cannot be covered by law under workers’ compensation or any similar law);• Excluded pre-existing conditions (see definition).The loss of a professional or occupational license does not, in itself, constitute disability.Termination of coverageYour coverage under the policy ends on the earliest of the following:• The date the policy or plan is cancelled• The date you no longer are in an eligible group• The date your eligible group is no longer covered• The last day of the period for which you made any required contributions• The last day you are in active employment except as provided under the covered layoff or leave of absence provision.Unum will provide coverage for a payable claim that occurs while you are covered under the policy or plan.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 Policy Form C.FP-1 et al., or contact your Unum representative.Underwritten by:Short Term Disability InsuranceUnum Life Insurance Company of America, Portland, Maine© 2020 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.21

Page 16

Unum | Long Term Disability Insurance 710365EN-351050 FOR EMPLOYEES (3-22) How does it work?This coverage provides a monthly benefit if you have a covered illness or injury and you can’t work for a few months — or even longer.Your employer is providing you a base amount of coverage.You also have the opportunity to purchase additional coverage to be sure your financial needs are met.You’re generally considered disabled if you’re unable to do important parts of your job — and your income suffers as a result. You can use the money however you choose. It can help you pay for your rent or mortgage, groceries, out-of pocket medical expenses and more.Why is this coverage so valuable?If you didn’t get coverage when you were first eligible, you’ll have to answer health questions now. If you‘re newly eligible, you may not have to answer health questions.What else is included?Work-life balance Employee Assistance Program Get access to professional help for a range of personal and work-related issues, including counselor referrals, financial planning and legal support.Worldwide emergency travel assistance One phone call gets you and your family immediate help anywhere in the world, as long as you’re traveling 100 or more miles from home. However, a spouse traveling on business for his or her employer is not covered. Survivor benefit If you die while you’ve been disabled and receiving benefits for at least 180 days, your family could get a benefit equal to 3 months of your gross disability payment.Waiver of premiumIf you’re disabled and receiving benefit payments, Unum waives your cost until you return to work.COVERAGE AMOUNTSEmployer-paid coverageYour employer is providing a benefit of 40% of your monthly earnings to a maximum of $7,500.Employee optional additional coverageYou can elect to purchase a benefit of 66.67% of your monthly earnings to a maximum of $12,500.The monthly benefit may be reduced or offset by other sources of income. The IRS may require you to pay taxes on certain benefit payments. See your tax advisor for details.Employer-paid and optional additional coverage: Your elimination period is 180 days.This is the number of days that must pass after a covered illness or injury before you can begin to receive benefits.Employer-paid and Employee Optional Additional Long Term Disability InsuranceEmployer-paid and optional additional coverage: You can receive benefits up to the Social Security (SS) normal retirement age.This is the maximum length of time you can receive benefits while you’re disabled.BENEFIT DURATIONELIMINATION PERIOD

Page 17

Page 18

Unum | Long Term Disability Insurance 710365EN-351050 FOR EMPLOYEES (3-22) Exclusions and limitationsActive employeeYou are eligible for coverage if you are an active employee in the United States working a minimum of 30 hours per week. You are considered in active employment, if on the day you apply for coverage, you are being paid regularly by your employer for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation.Delayed effective date of coverageInsurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layo, or leave of absence on the date that insurance would otherwise become eective.Benefit DurationThe duration of your benet payments is based on your age when your disability occurs. Your Long Term Disability benets are payable while you continue to meet the denition of disability. Please refer to your plan document for the duration of benets under this policy.Definition of disabilityYou are considered disabled when Unum determines that:• You are limited from performing the material and substantial duties of your regular occupation due to sickness or injury; and• You have a 20% or more loss of indexed monthly earnings due to the same sickness or injuryAfter 24 months, you are considered disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably tted by education, training or experience.You must be under the regular care of a physician in order to be considered disabled.The loss of a professional or occupational license or certication does not, in itself, constitute disability. “Substantial and material acts” means the important tasks, functions and operations that are generally required by employers from those engaged in your usual occupation and that cannot be reasonably omitted or modied.Pre-existing conditionsYou have a pre-existing condition if:• You received medical treatment, consultation, care or services including diagnostic measures for the condition, or took prescribed drugs or medicines for it in the 6 months just prior to your effective date of coverage; and• The disability begins in the first 12 months after your effective date of coverage.Deductible sources of incomeYour disability benet may be reduced by deductible sources of income and any earnings you have while you are disabled, including such items as group disability benets or other amounts you receive or are entitled to receive:• Workers’ compensation or similar occupational benefit laws, including a temporary disability benefit under a workers’ compensation laws• State compulsory benefit laws• Automobile liability insurance policy• No fault motor vehicle plan• Third-party settlements• Other group insurance plans• A group plan sponsored by your employer• Governmental retirement system• Salary continuation or sick leave plans - if included• Retirement payments• Social Security or similar governmental programsExclusions and limitationsBenets will not be paid for disabilities caused by, contributed to by, or resulting from:• Intentionally self-inflicted injuries;• Active participation in a riot;• War, declared or undeclared or any act of war;• Commission of a crime for which you have been convicted;• Loss of professional license, occupational license or certification; or• Pre-existing conditions (See the disclosure section to learn more).The loss of a professional or occupational license does not, in itself, constitute disability.Unum will not pay a benet for any period of disability during which you are incarcerated.The lifetime cumulative maximum benet for all disabilities due to mental illness is 24 months. Only 24 months of benets will be paid for any combination of such disabilities even if the disabilities are not continuous and/or are not related. Payments can continue beyond 24 months only if you are conned to a hospital or institution as a result of the disability.Termination of coverageYour coverage under the policy ends on the earliest of the following:• The date the policy or plan is cancelled• The date you no longer are in an eligible group• The date your eligible group is no longer covered• The last day of the period for which you made any required contributions• The last day you are in active employment except as provided under the covered layoff or leave of absence provision.Unum will provide coverage for a payable claim that occurs while you are covered under the policy or plan.Unum’s LTD contracts standardly include a provision called the Social Security Claimant Advocacy Program. With this feature, claimants can receive expert advice and assistance from us regarding their Social Security Disability claim during the application and appeal process. Social Security advocacy services are provided by GENEX Services, LLC or Brown & Brown Absence Services Group. Referral to one of our advocacy partners is determined by Unum.Worldwide emergency travel assistance services are provided by Assist America, Inc. Work-life balance employee assistance program services are provided by HealthAdvocate. Services are available with select Unum insurance offerings. Terms and availability of service are subject to change and prior notification requirements. Service providers do not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.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 Policy Form C.FP-1 et al. or contact your Unum representative.Underwritten by:Unum Life Insurance Company of America, Portland, Maine© 2022 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Page 19

EN-1974 (1-20) FOR EMPLOYEES R0804278XYZ Brokerage FirmAccident Insurance can pay you money for covered accidental injuries and their treatment.How does it work?Accident Insurance can pay a set beneﬁt amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job. And it includes a range of incidents, from common injuries to more serious events.Who can get coverage?Why is this coverage so valuable?•It can help you with out-of-pocket coststhat your medical plan doesn’t cover, likeco-pays and deductibles.• You’re guaranteed base coverage, withoutanswering health questions.•The cost is conveniently deducted from yourpaycheck.•You can keep your coverage if you changejobs or retire. You’ll be billed directly.You If you’re actively at work*Your spouse Ages 17 and upYour 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. Spouses and dependent children must reside in the United States to receive coverage.What’s included? Wellness BeneﬁtEvery year, each family member who has Accident coverage can also receive $50 for getting a health screening test, such as:•Blood tests•Chest X-rays•Stress tests•Colonoscopies•MammogramsSickness Hospital Conﬁnement BeneﬁtThis optional beneﬁt pays a daily amount if you’re in the hospital for a covered illness. It’s available to each family member who has Accident coverage. You can receive $200 per day. Coverage for children is 75% of that amount.– The beneﬁt has a 12-month pre-existing conditionlimitation. You and your spouse need to answer somehealth questions to receive this beneﬁt.How much does it cost?Monthly PremiumPremium with optional Sickness Hospital Conﬁnement BeneﬁtYou $19.53 $24.11You and your spouse $31.93 $41.09You and your child(ren) $32.94 $42.48You, your spouse and child(ren)$45.34 $59.46For illustrative purposes only. Actual cost may vary.27

Page 20

EN-1974 (1-20) FOR EMPLOYEESR0804278Accident Insurance – Schedule of BeneﬁtsCovered injuries Benefit amountFracturesOpen Reduction(dependent on location of injury) $200 to $10,000Closed Reduction(dependent on location of injury) $100 to $5,000Chips 25% of closed amountDislocationsOpen Reduction(dependent on location of injury) $400 to $8,000Closed Reduction(dependent on location of injury) $200 to $4,000BurnsAt least 10 square inches, but less than 20 square inches2nd degree – $0 3rd degree – $3,750At least 20 square inches, but less than 35 square inches2nd degree – $0 3rd degree – $7,50035 or more square inches of the body surface2nd degree – $1,500 3rd degree – $15,000Skin grafts for 2nd and 3rd degree burns 50% of burn benefitSkin graft for any other accidental traumatic loss of skinAt least 10 square inches, but less than 20 square inches $225At least 20 square inches, but less than 35 square inches $37535 or more square inches of the body surface $750Concussion $200Coma $15,000Ruptured disc $1,000Knee cartilageTorn with surgical repair $1,000Exploratory surgery or cartilage shaved, only $200Laceration $50–$800Tendon/ligament and rotator cuffSurgical repair of one $1,000Surgical repair of two or more $1,500Exploratory surgery without repair $200Dental work, emergencyExtraction $150Crown $450Eye injury $400Emergency and hospitalization benefitsBenefit amountAmbulance(ground, once per accident) $600Air ambulance $2500Emergency room treatment $150Emergency treatment in physician office/urgent care facility $100Hospital admission (admission or intensive care admission once per covered accident) $1,500Intensive care admission (same as above) $2,250Hospital confinement (per day up to 365 days) $400Intensive care confinement (per day up to 15 days) $600Medical imaging test (once per accident) $400Outpatient surgery facility service(once per accident) $500Pain management(epidural, once per accident) $150Treatment and other servicesBenefit amountSurgery benefitOpen abdominal, thoracic $2,000Exploratory (without repair) $200Hernia repair $200Physician follow-up visit(2 visits per accident) $100Chiropractic visit(up to 3 visits per calendar year) $35Therapy services (up to 10 per accident)Occupational therapy $35Speech therapy $35Physical therapy $35Prosthetic device or artificial limbOne $1,000More than one $2,000Appliance (once per accident) $200Blood, plasma and platelets $500Travel due to accident Transportation of more than 50+ miles from residence; 3 trips per accident; max 1,200 miles per round trip $0.50 per mileLodging (per night up to 30 days per accident) $200Rehabilitation unit confinement (per day up to 15 days; max 30 days per calendar year) $150Accident coverage is a limited policy.In TX, additional beneﬁts are available for acquired brain injury, telehealth service and telemedicine service.The 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 policy form GA-1 or contact your Unum representative. Level 3 with AD&DUnderwritten by:Unum Life Insurance Company of America, Portland, Maine© 2020 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.Accidental death and other covered lossesBenefit amountAccidental death*Employee $100,000Spouse $40,000Child $20,000*The accidental death beneﬁt doubles if the insured individual is injured as a fare-paying passenger on a common carrier: Employee–$200,000; spouse–$80,000; child–$40,000Initial accidental dismemberment — one benefit per accident, not payable with initial accidental lossLoss of both hands or both feet; or $30,000Loss of one hand and one foot; or $30,000Loss of one hand or one foot; $15,000Loss of two or more fingers, toes or any combination; or $2,500Loss of one finger or toe $1,500Catastrophic accidental dismemberment† — once per lifetime, not payable with catastrophic loss Loss of both hands or both feet; or loss of one hand and one footEmployee (prior to age 65) $100,000 Spouse and child $50,000Employee (ages 65–69) $50,000 Spouse and child $25,000Employee (70+ years old) $25,000 Spouse and child $12,500Accidental loss — paralysis, sight, hearing and speech Initial accidental loss — one benefit per accident, not payable with initial dismembermentPermanent paralysis; or $30,000Loss of sight of both eyes; or $30,000Loss of sight of one eye; or $15,000Loss of the hearing of one ear $15,000Catastrophic accidental loss† — once per lifetime, not payable with catastrophic dismembermentPermanent paralysis; or loss of hearing in both ears; or loss of the ability to speak; or loss of sight of both eyesEmployee (prior to age 65) $100,000 Spouse and child $50,000Employee (ages 65–69) $50,000 Spouse and child $25,000Employee (70+ years old) $25,000 Spouse and child $12,500†Catastrophic accidental beneﬁt — payable after fulﬁlling a 365 day elimination period.28

Page 21

EN-1974 (1-20) FOR EMPLOYEESR0804278Accident InsuranceSee Schedule of Benefits for a complete listing of what is covered.THIS IS A LIMITED BENEFITS POLICY. Effective date of coverageCoverage becomes effective on the first day of the month in which payroll deductions begin.Exclusions and limitationsUnum will not pay benefits for a claim that is caused by, contributed to by or occurs as a result of:• participating in war or act of war, whether declared or undeclared;• committing acts of terrorism;• riding in or driving any motor-driven vehicle in a race, stunt show or speed test;• operating, learning to operate, serving as a crew member of or jumping, parachuting, or falling from any aircraft or hot air balloon, including those which are not motor-driven. This does not include flying as a fare paying passenger;• engaging in hang-gliding, bungee jumping, sailgliding, parasailing, parakiting;• participating or attempting to participate in a felony, being engaged in an illegal occupation or being incarcerated in a penal institution;• committing or trying to commit suicide or injuring oneself intentionally, whether sane or not;• practicing for or participating in any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received;• having any sickness or declining process caused by a sickness, including physical or mental infirmity including any treatment for allergic reactions. Unum also will not pay benefits to diagnose or treat the sickness. Sickness means any illness, infection, disease or any other abnormal physical condition which is not caused by an injury. In addition to the exclusions listed above, Unum will also not pay the catastrophic accidental dismemberment or catastrophic accidental loss benefit for the following injuries that are caused by or are the result of:• an insured’s being intoxicated or under the influence of any narcotic unless administered on the advice of a physician; or• injuries to a dependent child received during the birth.Sickness Hospital Confinement Benefit exclusionsUnum will not pay benefits for a claim that is caused by, contributed to by or occurs as a result of:• participating in war or act of war, whether declared or undeclared;• committing acts of terrorism;• treatment for alcoholism or drug addiction, unless the insured is addicted to a narcotic taken on the advice of a physician;• treatment for dental care or dental care procedures;• elective procedures and/or cosmetic surgery or reconstructive surgery, unless it is a result of trauma, infection or other diseases;• having a pre-existing condition as described and limited by this benefit;• hospital confinement caused by, contributed to by, or resulting from your mental illness. However, dementia as a result of stroke, trauma, viral infection, Alzheimer’s disease or other conditions not listed which are not usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment are covered under this policy;• any hospital confinement of a newborn following the birth unless the newborn is sick or injured.Pre-existing conditions for the Sickness Hospital Confinement BenefitUnum will not pay benefits for a claim that is caused by, contributed to by or occurs as a result of a pre-existing condition or any medical or surgical treatment for that condition for which the date of confinement is in the first 12 months after the insured’s coverage effective date. Pre-existing condition means a sickness or symptoms of a sickness, whether diagnosed or not, for which the insured received medical treatment, consultation, care or services, including diagnostic measures, took prescribed drugs or medicine or had been prescribed drugs or medicine to be taken during the 12 months just prior to the insured’s coverage effective date.Termination of employee coverageIf you choose to cancel your coverage under the policy, your coverage ends on the first of the month following the date you provide notification to your employer. Otherwise, your coverage under the policy ends on the earliest of the:• date this policy is cancelled;• date you are no longer in an eligible group;• date your eligible group is no longer covered;• date of your death;• last day of the period for which you made any required contributions; or last day you are in active employment. However, as long as premium is paid as required, coverage will continue in accordance with the layoff and leave of absence provisions of this policy. Unum will provide coverage for a payable claim which occurs while you are covered under this policy.THIS IS A LIMITED BENEFITS POLICYThis 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 Policy Form GA-1 et al. or contact your Unum representative.Unum complies with state civil union and domestic partner laws when applicable.Underwritten by:Unum Life Insurance Company of America, Portland, Maine© 2020 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.29

Page 22

EN-1972 (7-18) FOR EMPLOYEESXYZ Brokerage FirmCritical Illness Insurancecan pay money directly to you when you’re diagnosed with certain serious illnesses.How does it work?If you’re diagnosed with an illness that is covered by this insurance, you can receive a beneﬁt payment in one lump sum. You can use the money however you want.Why is this coverage so valuable?•The money can help you pay out-of-pocket medicalexpenses, like co-pays and deductibles.•You can use this coverage more than once.Even after you receive a payout for one illness, you’restill covered for the remaining conditions. If you have adifferent condition later, you can receive another beneﬁt.•This insurance pays you once for each eligible illness.However, the diagnoses must be at least 90 days apart,and the conditions can’t be related to each other.What’s covered?•Heart attack•Blindness•Major organ failure•End-stage kidney failure• Benign brain tumor•Coronary artery bypass surgery (pays at 25% of lump sumbeneﬁt)•Coma that lasts at least 14 consecutive days•Stroke whose effects are conﬁrmed at least 30 days afterthe event•Occupational HIV•Permanent paralysis of at least two limbs due to a coveredaccidentCoverage is also included for:•Cancer•Carcinoma in situ — pays 25% of your coverage amount.(Carcinoma in situ is deﬁned as cancer that involves onlycells in the tissue in which it began and that has notspread to nearby tissues.)Why should I buy coverage now?• It’s more affordable when you buy it through youremployer.• The cost is conveniently deducted from yourpaycheck.• You can keep coverage if you leave the companyor retire. You’ll be billed at home.Please refer to the policy for complete details about these covered conditions. Coverage may vary by state. See exclusions and limitations. Effective date of coverage: Coverage becomes effective on the first day of the month in which payroll deductions begin. Employees must be legally authorized to work in the United States and actively working at a U.S. location to receive coverage. Spouses and dependent children must reside in the United States to receive coverage.What else is included?A Wellness BeneﬁtEvery year, each family member who has Critical Illness coverage can also receive $75 for getting a health screening test, such as:•Blood tests•Chest X-rays•Stress tests• Colonoscopies•Mammograms•And other tests listed in your policy25

Page 23

Page 24

EN-1972 (7-18) FOR EMPLOYEESExclusions and limitationsIndividuals must have comprehensive medical coverage to be eligible for this critical illiness insurance.Waiting periodThe benefit for this coverage is subject to a 30-day waiting period following the effective date of the insured’s coverage. This does not apply to coma, occupational HIV and permanent paralysis or specific covered childhood diseases.Pre-existing conditionsBenefits for a pre-existing condition (defined as a sickness or injury, or symptoms of a sickness or injury, whether diagnosed or not, for which you received medical treatment, consultation, care or services, including diagnostic measures, took prescribed drugs or medicine, or had been prescribed drugs or medicine to be taken in the 12 months just prior to your effective date) will not be paid during the first 12 months the policy is inforce.Reduction of benefitsAny coverage inforce prior to the insured’s 70th birthday will be reduced on the policy anniversary date following the insured’s 70th birthday. The insured’s face amount will be reduced to 50% of the face amount the insured had prior to the policy anniversary date. Any coverage inforce after the policy anniversary date following the insured’s 70th birthday will not be subject to a benefit reduction on subsequent policy anniversary dates.Exclusions and limitationsUnum will not pay benefits for a claim that is caused by, contributed to by or occurs as a result of:• Participating or attempting to participate in a felony or being engaged in an illegal occupation; or• Committing or trying to commit suicide or injuring oneself intentionally, whether sane or not; or• Participating in war or any act of war, whether declared or undeclared; or• Committing acts of terrorism; or• Being under the influence of or addicted to intoxicants or narcotics. This would not include physician-prescribed medication, taken in the prescribed dosage; or • Having a date of diagnosis during the benefit waiting period.Termination of employee coverageIf you choose to cancel your coverage under the policy, your coverage ends on the first of the month following the date you provide notification to your employer. Otherwise, your coverage under the policy ends on the earliest of the:•Date this policy is canceled;•Date you are no longer in an eligible group;• Date your eligible group is no longer covered;• Date of your death;• Last day of the period for which you made any required contributions; or• Last day you are in active employment. However, as long as premium is paid as required, coverage will continue if you elect to continue coverage under the portability provision or in accordance with the Layoff and Leave of Absence provisions of this policy.Coverage on your dependent children ends on the earliest of the date your coverage under this policy ends or the date a dependent child no longer meets the definition of dependent children.Unum will provide coverage for a payable claim which occurs while you are covered under this policy.THIS INSURANCE PROVIDES LIMITED BENEFITSThis 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 imitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form CI-1 or contact your Unum representative. Underwritten by:Unum Life Insurance Company of America, Portland, Maine© 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.Critical Illness InsuranceWho can get coverage?Coverage is guaranteed up to the stated amount. If you don’t sign up now but decide to apply later, you may have to answer medical questions. You: Choose $5,000 or $10,000 of coverage. Coverage is guaranteed up to $10,000 if you apply during this enrollment. If you do not sign up now but decide to apply later, you may have to answer medical questions.Your spouse:Spouses from ages 17 and up can get $5,000 of coverage during this enrollment. Coverage is guaranteed as long as you have purchased coverage for yourself.Your children:Dependent children from newborns to age 26 are automatically covered at no extra cost. Their coverage amount is 50% of yours. They are covered for all the same illnesses, plus these speciﬁc childhood conditions: cerebral palsy, cleft lip or palate, cystic ﬁbrosis, Down syndrome and spina biﬁda. The diagnosis must occur after the child’s coverage effective date.Monthly premium for $1,000 of coverageAge Non-tobacco Tobacco0 -24 $0.43 $0.6125-29 $0.47 $0.7430-34 $0.68 $1.1035-39 $0.93 $1.6140-44 $1.31 $2.3645-49 $1.80 $3.2650-54 $2.38 $4.3555-59 $3.14 $5.5460-64 $4.02 $6.6365-69 $4.52 $6.9170-99 $8.10 $11.14Monthly Premium for Wellness BenefitEmployee and children $2.40Spouse $2.40Your paycheck deduction includes base coverage and Wellness Benefit premium[s]. Actual billed amounts may vary.For illustrative purposes only.26

Page 25

Many American employers and employeesbelieve that their health insurance policiescover most, if notall ambulance expenses.The truth is, they DONOT!Even after insurance payments for emergency transportation, you couldreceive a bill up to $5,000 for ground ambulance and as high as $70,000 for air ambulance. The financial burdens for medical transportation costs are very real.EMERGENCY TRANSPORTATION COSTSMASA MTS is here to protect its members and their families from the shortcomings of health insurance coverage by providing them with comprehensive financial protection for lifesaving emergency transportation services, both at home and away fromhome.HOW MASA IS DIFFERENTAcross the US there are thousands of ground ambulance providers and hundreds of air ambulance carriers. ONLY MASA offers comprehensive coverage since MASA is a PAYER and not aPROVIDER!ONLY MASA provides over 1.6 million members with coverage for BOTH ground ambulance and air ambulance transport, REGARDLESS of whichprovider transports them.Members are covered ANYWHERE in all50 states andCanada!Worldwide coverage is also availablewith our Platinum Membership.Additionally, MASA provides a repatriation benefit: if a member is hospitalized more than 100 miles from home, MASA can arrange and pay to have them transported to a hospital closer to their place ofresidence.Emergent Ground TransportationEmergent Air TransportationNon-EmergentAir TransportationMortal Remains TransportationOrganRecipient TransportationU.S./CanadaU.S./CanadaWorldwideRepatriation WorldwideEscort Transportation WorldwideWorldwideVisitor TransportationBCA**MinorChildren/Grandchildren BCA**ReturnVehicle Return BCA**Pet ReturnBCA**Organ RetrievalU.S./CanadaU.S./CanadaU.S./CanadaU.S./CanadaU.S./CanadaU.S./CanadaEmergent Plus$14/MonthA MASA Membership prepares you for the unexpected and gives you the peace of mind to access vital emergency medical transportation no matter where you live, for a minimal monthly fee.• One low fee for the entire family• NO deductibles• NO health questions• Easy claims processFor more information, pleasecontact Your MASA RepresentativeEVERY FAMILY DESERVES A MASA MEMBERSHIP** Basic Coverage Area (BCA) includes U.S.,Canada, Mexico, andCaribbean (excluding Cuba).OUR BENEFITSBenefitPlatinum$39/MonthAny Ground. Any Air.Anywhere.™* Please refer to the MSA for a detailed explanation of benefits and eligibility,*30

Page 26

Page 27

thrivesonbalance–balancingprofessionalandpersonalworlds–balancingworkandrest–whilealwaysbalancingcostandvalue.Wealsounderstandthatbalancemustbeindividualized.Whatisrightforonepersonmaynotbeappropriateforanother.Itisourgoaltoofferchoicesallowingyoutotailoryourbenefitsplanspecificallytowhatisbestforyouandyourfamilymembers.YourChoicesProvidesacompletepackageofBenefitPre-TaxorPostTaxWhopaysthecost?WhydoIpayforsomebenefitswithbefore-taxmoney?Whilenotallbenefitsqualifyforpre-taxcontribution,thereisadefiniteadvantagetopayingforthosethatdo:Takingthemoneyoutbeforeyourtaxesarecalculatedlowerstheamountofyourtaxableincome.Therefore,youpaylessintaxes.HowYourBenefitsWorkFull-timeemployeesareeligibleformostbenefitson_____________________________________ofhire.MakingChangesGenerally,youcanonlychangeyourbenefitschoicesduringtheannualBenefitsEnrollmentPeriod.However,youcanchangeyourbenefitschoicesduringtheyearifyouhavealifeeventchange.Lifeeventchangesincludebutarenotlimitedto:· Marriage· Divorce· Birth,adoption,orplacementforadoptionofaneligiblechild· Deathofyourspouseorcoveredchild· Changeinyouoryourspouse’sworkstatusthatresultsincancellationofyourbenefits· BecomingeligibleforMedicareorMedicaidduringtheyearIfyouhavealifeeventchange,youmustnotifyHumanResourceswithin31daysofthechange(forexample,amarriageorbirthcertificate).Ifyoudo notnotifyHumanResourceswithin31days,youwillhavetowaituntilthenextannualOpenEnrollmentperiodtomakebenefitschangesunlessyouhaveanotherlifeeventchange.Anychangesyoumaketoyourbenefitchoicesmustbedirectlyrelatedtothelifeeventchange.HealthInsuranceDentalInsuranceVisionInsuranceCriticalIllness& Accident VoluntaryLifeInsuranceShortTermDisabilityInsuranceLongTermDisabilityInsurance___XYZ Company_________________________________ XYZ Companybenefitsaimedatprovidingflexibleinsuranceprotection andprogramstomeetyourever-changingneeds.XYZ Company sharesthecostofsomebenefitswithyou,whilemakingadditionalbenefitsavailablethat youpayforifyouchoosetoenroll.Thepartofthe benefitcoststhatyouareresponsibleforwillbe automaticallydeductedfromyourpaycheck,either beforeorafteryourtaxesarecalculated.the first of the month following 60 daysXYZ CompanyPre-Tax Employer SharedPre-Tax EmployeePre-Tax EmployeePost-Tax EmployeePost-TaxPost-TaxEmployeePost Tax EmployeeEmployee4

Page 28

PortabilityIfyouleavethecompany,someofyourbenefitsendandsomeofyourbenefitsareportable.Thismeansyoucantakethemwithyouifyouleave,aslongasyoucontinuetopaythepremiumsyourself.Onceterminated,youwillbenotifiedthroughthemailifanyofyourbenefitsareportable.WhenCoverageEndsBenefitsendonthelastdayofthemonthfollowingterminationorwhenyouceasetomeeteligibilityguidelines.           Lookingahead……NOTES:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Continuing Your CoverageUndercertaincircumstances,youmay continue yourhealthcarecoveragewhenitwouldotherwiseend.Thisiscalled ___________________.Cobra/StateContinuationappliestotheseplans:· HealthInsurance· DentalInsurance· VisionInsuranceWhencan I continue coverage under____________________?Youand/oryourdependentsareeligibletocontinuehealthcarecoverageunder________________________If coverageislostbecause:· Your employment endsforanyreasonother than“grossmisconduct”.· Yourworkhours are significantlyreduced.· Youdie.· Youbecome entitled toandenrollinMedicarepriortolosingcoverage.· Youdivorceorbecomelegallyseparatedfromyourspouse.· Yourdependentlosesdependentstatus.CobraCobraCobraNowlet’slookateachbenefitthatmakesuptheXYZ Company benefitsprogram.Inthefollowingpages,you’lllearnmoreaboutthevaluable benefitsyouremployeroffers.You’llalsoseehow choosingtherightcombinationofbenefitscanhelp protectyouandyourfamily’shealth.5

Page 29

Page 30

Page 31

EN-2026 FOR EMPLOYEES (2-23) Unum | Dental InsuranceGlass Sorenson and McDavid Inc.What else is included?Pregnancy benefitAn extra cleaning for expecting mothers in their 2nd or 3rd trimester.Wellness benefitsOral cancer screenings for patients 40 and older with high risk factors.Unumdentalcare.comUse unumdentalcare.com to search for providers, manage your benefits and learn about good dental health. Features include easy access to ID Cards, claims history and coverage information.Virtual Dental Visits24/7 dental care for dental emergencies when an in-person visit isn’t an option. Available for active dental members*.Visit unumdentalcare.com and click Virtual Dental Visits to get started.Unum Dental™Dental Insurance can help you pay for dental exams, cleanings and other services.Why is this coverage so valuable?Routine dental care keeps your mouth and whole body healthy.Your plan is backed by Unum’s commitment to excellence in customer service.Personalized website to manage your benefits including claims information, ID cards and more.There’s no waiting period for preventive and basic services.How does it work?Good dental care is critical to your overall well-being. With Unum Dental insurance, you can get the attention your teeth need — at a cost you can afford.Unum Dental allows you to see any dentist you choose. To get the most from your benefits and reduce out-of-pocket costs, choose an in-network provider by utilizing our large national network. These providers have agreed to file your claims and uphold the highest quality standards. You can find in-network providers at unumdentalcare.com.*Virtual dental visits are a preventiveservice and subject to policy year benefit maximum.

Page 32

EN-2026 FOR EMPLOYEES (2-23) Unum | Dental InsuranceDependent childrenDependent age guidelines vary by state. Please refer to your policy certificate or call our Contact Center at (888) 400-9304.Services not listedIf you expect to require a dental service not included on this brochure, it may still be covered. Please call our Contact Center at (888) 400-9304 to confirm your exact benefits.Alternate treatmentUnum covers the least expensive most commonly used and accepted American Dental Association treatments. Plan members may elect a more expensive treatment, but will be responsible for the cost difference resulting from the more expensive procedure.Coverage details and costsOverview Passive PPOBenefit Year Maximum*$5,000Deductible**$50 in-network and out-of-network Maximum 3 per familyPlan Coinsurance In-network Out-of-NetworkClass A Preventive100% 100%Class B Basic80% 80%Class C Major50% 50%Class D Orthodontics50% 50%*Applies to Class A, B and C Services, if applicable **Waived for Class A (applies to Class B and C Services) Dental CoveragePassive PPOMonthly cost†You$37.26You and your spouse$73.75You and your children$95.87Family$143.23†Rates guaranteed for 12 months from the effective date.