LONG TERM DISABILITY BENEFIT INFORMATION HC13GPIN 17 B-21114 (11/25) NON-DEDUCTIBLE SOURCES OF INCOME We will not subtract from your gross monthly payment income you receive from the following: • 401(k) plans. • Salary continuation or accumulated sick leave plans. • Profit sharing plans. • Thrift plans. • Tax-sheltered annuities. • Stock ownership plans. • Credit disability insurance. • Non-qualified plans of deferred compensation. • Pension plans for partners. • Military pension plans. • Franchise disability income plans. • Individual disability plans wholly paid for by the insured person. • A retirement plan from another employer. • Individual retirement accounts (IRA). MINIMUM PAYMENT The minimum payment each month for a payable claim is $100. We may apply this amount to recover any outstanding overpayment. DURATION OF PAYMENTS We will send you a payment each month up to the maximum period of payment. Your maximum period of payment is stated in the BENEFITS AT A GLANCE, will be paid during a continuous period of disability, and will be based on your age at disability. WHEN PAYMENTS END We will stop sending you payments and your claim will end on the earliest of the following: • The end of the maximum period of payment. • The date you are no longer disabled under the terms of the policy. • The date you fail to submit proof of continuing disability. • The date you die. • During the regular occupation period when you are able to return to work in your regular occupation on a part-time basis but you do not. • After the regular occupation period, when you are able to work in any gainful occupation for which you are reasonably qualified based on your training, education and experience on a part-time basis but you do not. • The date your disability earnings exceed 80% of your indexed monthly earnings. • After 12 months of payments if you are considered to reside outside the United States or Canada. You will be considered to reside outside these countries when you have been outside the United States or Canada for a total period of 6 months or more during any 12 consecutive months of benefits. We will not pay a benefit for any period of disability during which you are incarcerated. DISABILITIES NOT COVERED UNDER THE POLICY The policy does not cover any disabilities caused by, contributed by, or resulting from your: • Loss of professional license, occupational license or certification. • Commission of or attempt to commit a felony. • Intentionally self-inflicted injuries. • Attempted suicide, regardless of mental capacity. • Being legally intoxicated or being under the influence of any narcotic, unless the narcotic is taken under the direction of and as directed by a doctor. • Participation in a war, declared or undeclared, or any act of war.
Monthly Disability Income Insurance Plan for Noblesville Schools Employees Page 17 Page 19