1. BENEFIT HIGHLIGHTS Accident insurance for all Insureds you elect to enroll will be based on the following: Benefit Coverage Type: 24-Hour Coverage Covered Benefits Unless otherwise specified, the following benefits will be payable only once for each Covered Accident as applicable. Refer to the Covered Accident Benefits section of this Certificate for additional benefit details. Life and Dismemberment Losses Amount of Benefit Low Plan Employee Spouse Child Accidental Death $15,000 $15,000 $7,500 Accidental Death Common Carrier $30,000 $30,000 $15,000 Catastrophic Loss: Loss of Arm or Loss of $7,500 $7,500 $3,750 Hand—both arms or both hands, Loss of Leg or Loss of Foot—both legs or both feet, Loss of Hand and Loss of Foot or Loss of Arm and Loss of Leg—one hand and one foot or one arm and one leg, Loss of an Eye—both eyes, irrecoverable Loss of Sight—both eyes, or any combination equaling two or more losses from: Loss of Arm, Loss of Hand, Loss of Leg, Loss of Foot or Loss of an Eye Accidental Dismemberment: Loss of Hand—one hand, Loss of $3,750 $3,750 $1,875 Foot—one foot, Loss of Leg—one leg or Loss of Arm—one arm Loss of a Finger or Loss of a Toe—two or $750 $750 $375 more fingers or toes Loss of a Finger or Loss of a Toe—one $375 $375 $188 finger or one toe Loss of Sight or Loss of an Eye—one eye $3,750 $3,750 $1,875 High Plan Employee Spouse Child Accidental Death $25,000 $25,000 $12,500 Accidental Death Common Carrier $100,000 $100,000 $50,000 Catastrophic Loss: Loss of Arm or Loss of $15,000 $15,000 $7,500 Hand—both arms or both hands, Loss of Leg or Loss of Foot—both legs or both feet, Loss of Hand and Loss of Foot or Loss of Arm and Loss of Leg—one hand and one foot or one arm and one leg, Loss of an Eye—both eyes, irrecoverable Loss of Sight—both eyes, or any combination equaling two or more losses from: Loss of Arm, Loss of Hand, Loss of Leg, Loss of Foot or Loss of an Eye Accidental Dismemberment: Loss of Hand—one hand, Loss of $7,500 $7,500 $3,750 Foot—one foot, Loss of Leg—one leg or 16-AC-C-01 Page5