LONG TERM DISABILITY BENEFIT INFORMATION HC13GPIN 22 B-21114 (11/25) SUPPLEMENTAL DISABILITY BENEFIT We will pay you an additional supplemental disability benefit equal to 13 1/3% of your monthly earnings, not to exceed $5,000 per month, if you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury, and one of the following is also true: • You are continuously unable to perform two or more activities of daily living (ADL), without stand-by help. • You have a cognitive impairment. • You have a terminal illness. RETROACTIVE BENEFIT If you are receiving or entitled to receive a monthly benefit due to your disability, we will pay a Retroactive Benefit if all of the following are true: • You have satisfied the elimination period. • You are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury. • You are not working due to your disability, and you were continuously not working during your elimination period due to your disability. • You were hospital confined for 14 consecutive days or more starting within 48 hours of the day your disability began. The Retroactive Benefit is payable in a lump sum and will equal 1/30th of your gross monthly payment for each day you were disabled during your elimination period. This benefit will be paid only once during your lifetime.