Class 5 Vol Life Highlight Sheet for Goshen Community Schools

Plan Highlights Group Supplemental and Dependent Life Insurance Goshen Community Schools ELIGIBILITY BENEFIT REDUCTION DUE TO AGE Each Active Full-Time Non Certified Personnel of the Employer Age Original Benefit Reduced to regularly working a minimum of 20 hours per week who were hired 70 50% prior to January 1, 2012 and all Active Full-Time Non Certified Personnel of the Employer regularly working a minimum of 30 RATES hours per week who were hired after January 1, 2012 as well as See attached Rate Sheet Bus Drivers of the Employer regularly working a minimum of 16 hours per week during the school year working 20 hours or more FEATURES per week, except any person working on a temporary or seasonal basis.  Accelerated Death Benefit Dependents: You must be insured for your Dependents to be  FMLA/MSLA Extension covered. Dependents are:  Portability  Your legal spouse who is not legally separated or divorced from you;  Your unmarried financially dependent children age birth to 26 years;  A person may not have coverage as both an Employee and Dependent;  Only one insured spouse may cover dependent children. BENEFIT AMOUNT Supplemental Life: Choose from a minimum of $10,000 to a maximum of $500,000 in $10,000 increments, not to exceed 5 times annual earnings. Spouse: Choose from a minimum of $5,000, a maximum of $250,000 in $5,000 increments, not to exceed 100% of employee amount. Child(ren): Birth to age 26 years: $2,000 to $10,000 in increments of $2,000. GUARANTEED ISSUE Initial eligibility period only Employee: $200,000 Spouse: $25,000 Child(ren): $10,000 CONTRIBUTION REQUIREMENTS Coverage is 100% Employee Paid. 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.