LONG TERM DISABILITY BENEFIT INFORMATION HC13GPIN 14 B-21113 (11/25) The amount figured in Step 4 is your monthly payment. If this amount is less than the MINIMUM PAYMENT amount under the policy, your payment will be subject to the MINIMUM PAYMENT provision. B. IF YOU ARE DISABLED AND WORKING, AND YOUR DISABILITY EARNINGS ARE AT LEAST 20% BUT LESS THAN OR EQUAL TO 80% OF YOUR INDEXED MONTHLY EARNINGS During the first 12 months of payments, the sum of your gross monthly payment plus disability earnings may be less than or equal to, but not more than, 100% of your indexed monthly earnings. If the sum exceeds 100% of your indexed monthly earnings, we will reduce your payment under the policy by the excess amount. To determine whether the sum of your gross monthly payment plus disability earnings is less than or equal to or exceeds 100% of your indexed monthly earnings, we will follow this process: 1. Multiply your monthly earnings by 60%. 2. The maximum benefit is $5,000 per month. 3. Compare the answers from Step 1 and Step 2. The lesser of these two amounts is your gross monthly payment. 4. Add your disability earnings to your gross monthly payment. If the answer in Step 4 above is less than or equal to 100% of your indexed monthly earnings, your monthly payment will be your gross monthly payment minus any deductible sources of income. If this amount is less than the MINIMUM PAYMENT amount under the policy, your payment will be subject to the MINIMUM PAYMENT provision. If the answer in Step 4 above is greater than 100% of your indexed monthly earnings, we will follow this process to figure your monthly payment: a. Add your disability earnings to your gross monthly payment. b. From the answer in Step a, subtract your indexed monthly earnings. If the result is zero or less, record your answer as zero. c. From your gross monthly payment, subtract the answer in Step b and any deductible sources of income. The amount figured in Step c is your monthly payment. If this amount is less than the MINIMUM PAYMENT amount under the policy, your payment will be subject to the MINIMUM PAYMENT provision. After 12 months of monthly payments, you will receive payments based on the percentage of income you are losing due to your disability. We will follow this process to determine your monthly payment: 1. Subtract your disability earnings from your indexed monthly earnings. 2. Divide the answer in Step 1 by your indexed monthly earnings. The result is your percentage of lost earnings. 3. From your gross monthly payment, subtract any deductible sources of income. 4. Multiply the answer in Step 2 by the answer in Step 3. The answer in Step 4 is your monthly payment. If this amount is less than the MINIMUM PAYMENT amount under the policy, your payment will be subject to the MINIMUM PAYMENT provision. C. IF YOU ARE DISABLED AND WORKING, AND YOUR DISABILITY EARNINGS ARE MORE THAN 80% OF YOUR INDEXED MONTHLY EARNINGS If you are working and your disability earnings are more than 80% of your indexed monthly earnings, no benefit will be payable. We may require you to send proof of your monthly disability earnings each month. We will adjust your payment based on your monthly disability earnings. As part of your proof of disability earnings, we can require that you send us appropriate financial records that we believe are necessary to substantiate your income.