26-Pay Rate Highlights for Voluntary Accident Insurance

Plan Highlights Voluntary Group Accident Insurance Goshen Community Schools COVERAGE Voluntary accident insurance provides a range of fixed, lump‐sum BI-WEEKLY PREMIUM benefits for injuries resulting from a covered accident, or for Coverage Premium accidental death and dismemberment (if included). These benefits Employee $ 6.72 are paid directly to the insured and may be used for any reason, Employee and Spouse $ 10.53 from deductibles and prescriptions to transportation and Employee & Children $ 10.85 childcare. Employee & Family $ 14.66 ELIGIBILITY FEATURES Each Active Full-Time Employee working 15 hours or more per  Portability to Employee Age 70 week, except for any person working on a temporary or seasonal  FMLA/MSLA Continuation basis.  Newlywed and Newborn Provision Dependents: You must be insured for your Dependents to be  24-Hour Travel Assistance Services covered. Dependents are:  24-Hour Coverage  Your legal spouse or domestic partner. Spouse must be under age 70 at date of application.  Your dependent children from birth to 26 years.  A person may not have coverage as both an Employee and Dependent. BENEFIT AMOUNT See Full Schedule of Benefits on next page BENEFIT REDUCTION DUE TO AGE (Applicable to AD&D coverage only) Age Original Benefit Reduced to 70 50% CONTRIBUTION REQUIREMENTS Coverage is 100% Employee Paid. www.reliancestandard.com This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-9547, et al. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state.