Class 4 Basic Life Highlight Sheet for Goshen Community Schools

Plan Highlights Group Basic Life / AD&D Insurance Goshen Community Schools ELIGIBILITY BENEFIT REDUCTION DUE TO AGE EachActiveFull-TimeCertified Personnel, Full-Time Director Age Original Benefit Reduced to and Board Memberwo rking8hoursormoreperwee k, 70 50% exceptforanyperson workingonatemporaryorseasonal basis. FEATURES  Accelerated Death Benefit BENEFITAMOUNT  Air Bag Benefit BasicLifeandAD&D: $50,000  Conversion Privilege  FMLA/MSLA Extension GUARANTEEDISSUE  Portability $50,000  Seat Belt Benefit CONTRIBUTIONREQUIREMENTS  Waiver of Premium Coverageis100%EmployerPaid. VALUE-ADDED SERVICES AD&D SCHEDULE For Accidental Loss of Amount Payable  Bereavement Counseling Services Life 100%  Travel Assistance Services Both Hands 100% Both Feet 100% Sight of Both Eyes 100% One Hand and One Foot 100% One Hand and Sight of One Eye 100% One Foot and Sight of One Eye 100% Speech and Hearing 100% One Hand 50% One Foot 50% Sight of One Eye 50% Speech 50% Hearing 50% For Total Loss of Amount Payable Both Arms and Both Legs 100% Both Arms and One Leg or 75% Both Legs and One Arm Both Arms 67% Both Legs 67% One Arm and One Leg 67% One Arm or One Leg 50% www.reliancestandard.com This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-6422, 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.