Critical Illness cert

SUN LIFE ASSURANCE COMPANY OF CANADA Executive Office: One Sun Life Executive Park Wellesley Hills, MA 02481 (800) 247-6875 www.sunlife.com/us Sun Life Assurance Company of Canada certifies that it has issued and delivered a Group Insurance Policy to the Policyholder shown below. Policy Number: 917800-002 Policy Effective Date: January 1, 2019 Policyholder: DePauw University Employer: DePauw University Issue State: Indiana NOTICE TO BUYER: THIS IS A LIMITED BENEFIT HEALTH CERTIFICATE. THIS CERTIFICATE PROVIDES LIMITED BENEFITS. BENEFITS PROVIDED ARE SUPPLEMENTAL AND NOT INTENDED TO COVER ALL MEDICAL EXPENSES PLEASE READ YOUR CERTIFICATE CAREFULLY. This Certificate contains the terms of the Group Insurance Policy that affect your insurance. This Certificate is part of the Group Insurance Policy. This Certificate is governed by the laws of the Issue State shown above unless preempted by the federal Employee Retirement Income Security Act. Signed at Wellesley Hills, Massachusetts. Dean A. Connor Troy Krushel President and Chief Executive Officer Vice-President, Associate General Counsel and Corporate Secretary Group Critical Illness Insurance Certificate Non-Participating 16-SD-C-01 Page1

Questions regarding your policy or coverage should be directed to: Sun Life Assurance Company of Canada Attn: Customer Relations PO Box 9106 Wellesley Hills, MA 02481 (800) 247-6875 If you (a) need the assistance of the governmental agency that regulates insurance; or (b) have a complaint you have been unable to resolve with your insurer you may contact the Department of Insurance by mail, telephone or email: State of Indiana Department of Insurance Consumer Services Division 311 West Washington Street, Suite 300 Indianapolis, Indiana 46204 Consumer Hotline: (800) 622-4461; (317) 232-2395 Complaints can be filed electronically at www.in.gov/idoi 16-SD-C-01 Page2

TABLE OF CONTENTS SECTION BENEFIT HIGHLIGHTS 1 DEFINITIONS 2 ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF EMPLOYEE INSURANCE 3 ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF SPOUSE INSURANCE 4 ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF DEPENDENT CHILDREN 5 INSURANCE BENEFIT PROVISIONS 6 COVERED CONDITIONS 7 EXCLUSIONS AND LIMITATIONS 8 WELLNESS SCREENING BENEFIT 9 CLAIM PROVISIONS 10 INSURANCE CONTINUATION 11 PORTABILITY 12 GENERAL PROVISIONS 13 16-SD-C-01 Page3

1. BENEFIT HIGHLIGHTS Eligible Classes: All Full-Time United States Employees working in the United States scheduled to work at least 30 hours per week. Eligibility Waiting Period: None 16-SD-C-01 Page4

1. BENEFIT HIGHLIGHTS At the time of enrollment, you may be eligible to select an amount of Critical Illness insurance. We will pay benefits corresponding to the elections you made as shown below. You may change your or your Spouse's and Dependent Children's amount of Critical Illness insurance according to the When can you make Changes in Insurance provision. Any limitation applies separately to you, your Spouse and Dependent Children. Please see Covered Conditions and Exclusions and Limitations for a complete description of benefits, limitations and exclusions. Insurance Amounts Employee Insurance Minimum: $5,000 Maximum: $20,000 Change Increment Amount: $5,000 Spouse Insurance Minimum: $2,500 Maximum: $10,000 Change Increment Amount: $2,500 Dependent Children Insurance Minimum: $2,500 Maximum: $5,000 Change Increment Amount: $2,500 The Spouse and Dependent Children Insurance Amount will not be more than 50% of your Insurance Amount. Age Reduction If you are age 70 or more on the date you apply for Employee Insurance, your amount of Employee Insurance will be limited to 50% of the amount that you could have otherwise elected rounded to the next higher multiple of $1,000, if not already an exact multiple. If you were insured before age 70, your amount of Employee Insurance shown above reduces to 50% rounded to the next higher multiple of $1,000, if not already an exact multiple when you reach age 70. Your Spouse and Dependent Children Insurance Amount will be reduced if it exceeds 50% of your amount following an age reduction. This reduction will take effect on the January 1st following the date of change. No further increases to your benefit amount will be allowed after the age reduction has been applied. Any reduction will be subject to the other provisions of the Policy. 16-SD-C-01 Page5

1. BENEFIT HIGHLIGHTS If you enrolled in this option, your insurance will be based on the following. Core Conditions Category – Employee, Spouse and Dependent Children Insurance Covered Condition Benefit Percentages Recurrence Benefit Percentages Heart Attack 100% 100% Stroke 100% 100% Major Organ Failure 100% 100% Occupational Infectious Diseases 100% N/A End-stage Kidney Disease 100% 100% Coronary Artery Bypass Graft 25% 25% Angioplasty 5% 5% Cancer Conditions Category – Employee, Spouse and Dependent Children Insurance Covered Condition Benefit Percentages Recurrence Benefit Percentages Invasive Cancer 100% N/A Non-Invasive Cancer 25% N/A Skin Cancer 5% N/A Other Conditions Category – Employee, Spouse and Dependent Children Insurance Covered Condition Benefit Percentages Recurrence Benefit Percentages Benign Brain Tumor 100% N/A Coma 100% N/A Complete Blindness 100% N/A Paralysis 100% N/A Loss of Speech 100% N/A Complete Loss of Hearing 100% N/A Advanced ALS/Lou Gehrig’s 100% N/A Disease Advanced Alzheimer’s Disease 25% N/A Advanced Parkinson’s Disease 25% N/A Severe Burns 100% N/A Childhood Conditions Category – Dependent Children Insurance Covered Condition Benefit Percentages Recurrence Benefit Percentages Down Syndrome 100% N/A Cerebral Palsy 100% N/A Complex Congenital Heart 100% N/A Disease Cystic Fibrosis 100% N/A Spina Bifida 100% N/A Cleft Lip/Palate 100% N/A Type 1 Diabetes Mellitus 100% N/A Muscular Dystrophy 100% N/A Maximum Benefits Payable for each Insured under this Certificate: · Each Covered Condition is payable 1x during the lifetime of the Policy (except as described in the Recurrence Benefit provision). 16-SD-C-01 Page6

1. BENEFIT HIGHLIGHTS Wellness Screening Benefit: $50 per Benefit Year if any one of the wellness screening tests described in this Certificate is performed for you. $50 each Benefit Year if any one of the wellness screening tests described in this Certificate is performed for your insured Spouse and Dependent Children. Contributions: The cost of your insurance is paid for entirely by you. This is your Contributory insurance. 16-SD-C-01 Page7

2. DEFINITIONS Actively at Work means that you perform all the regular duties of your job for a full work day at your Employer’s normal place of business, a site approved by your Employer or a site where your Employer’s business requires you to travel. You will be considered Actively at Work if you usually perform the regular duties of your job at your home as long as you can perform all the regular duties of your job for a full work day and could do so at your Employer’s normal place of business. You are considered Actively at Work on any day that is not your regular scheduled work day (e.g., you are on vacation or holiday) as long as you were Actively at Work on your immediately preceding scheduled work day, and you are neither Confined nor disabled due to an Injury or sickness. Activities of Daily Living means: · Bathing – washing oneself by sponge bath; or in either a tub or shower, including the task of getting into or out of the tub or shower. · Continence – the ability to maintain control of bowel and bladder function; or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for a catheter or colostomy bag). · Dressing – putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs. · Eating – feeding oneself by getting food into the body from a receptacle (such as a plate, cup, or table) or by feeding tube or intravenously. · Toileting – getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene. · Transferring – moving into or out of a bed, chair or wheelchair. The assessment must be made by a medical professional such as an occupational therapist or equivalent. Benefit Percentage means the percentage that is applied to the Insurance Amount to determine the amount of Critical Illness benefits payable under the Policy. Benefit Year means a calendar year beginning on January 1 of any year and ending on December 31 of that year. Clinical Diagnosis means a Diagnosis of Cancer based on observation and history, diagnostic and laboratory studies, and symptoms. Confined or Confinement means: · confined to a hospital or similar facility; or · confined at home due to a sickness or Injury and under the care of a Physician. Contributory means you pay all or part of the premium. Coronary Artery Disease means acute coronary occlusion, coronary atherosclerosis, aneurysm and dissection of the coronary arteries or coronary atherosclerosis due to plaque. Critical Illness means only the illnesses defined in the Covered Conditions section of this Certificate for which benefits are payable. Dependent means your insured Spouse and Dependent Children. Dependent Child (Dependent Children) means your unmarried or married child under age 26. Dependent Child includes: 16-SD-C-01 Page8

2. DEFINITIONS · your step-child; · a foster child placed with you by a licensed agency; · a child for whom you have or your Spouse has legal guardianship of the child’s person; · your adopted child, including any child placed with you for adoption from the earlier of the date of placement for the purpose of adoption or the date of the entry of an order granting the adoptive parent custody of the child for the purpose of adoption; or · a child of your Spouse. If a unmarried or married child is age 26 or older and is incapable of self-sustaining employment because of an intellectual disability, developmental disability or physical handicap that child will continue to be considered a Dependent Child under the Policy for as long as these conditions exist. No person may be considered to be a Dependent Child of more than one Employee. Dependent Child does not include any person who is insured as an Employee. Diagnosed, Diagnosis or Diagnoses means an evaluation of an Insured’s medical condition that is performed by a Physician whose specialty is appropriate for the condition being evaluated, and who is board certified in that specialty in accordance with the American Board of Medical Specialties criteria. The evaluation must be consistent with the most current medically accepted diagnostic standards according to Nationally Recognized Authorities. A Diagnosis must be based on conditions, clinical signs on examination, or test results that have changed substantially since becoming insured under the Policy. In addition, if cognitive function is being evaluated, the conclusions must be confirmed with neuropsychological testing conducted by a clinical psychologist at the doctorate level certified through the American Board of Professional Psychology in the area of clinical neuropsychology. Eligibility Waiting Period means the length of time you must be a member in an Eligible Class before you can apply for insurance. The Eligibility Waiting Period is shown in the Benefit Highlights. Employee means a person who is: · employed by the Employer within the United States; · a U.S. citizen or a U.S. resident; · scheduled to work at least the minimum hours shown in the Benefit Highlights; · paid regular earnings in accordance with applicable state and federal wage and hour laws; and · has a legitimate federal tax identification number. Employee does not include a seasonal or temporary employee whose annual work schedule is less than 12 months during a calendar year. If you are an Employee and you are working on a temporary assignment outside of the United States for 12 months or less, you will be deemed to be working within the United States. If you are an Employee and you are working on a temporary assignment outside of the United States for more than 12 months, you will not be considered an Employee under the Policy unless we agree in Writing. Employer means the Employer named on the cover page of this Certificate and includes any subsidiary or affiliated company named in the application. Enrollment Period means the period of time each year not to exceed 30 days during which eligible Employees may elect, or change, or cancel insurance under the Policy. The Enrollment Period cannot exceed 30 days or occur more than once in any 12-month period, unless we agree in Writing. Family Member means: (a) your Spouse, civil union partner or domestic partner and (b) the following relatives of you or your Spouse, civil union partner or domestic partner: (1) parent; (2) grandparent; (3) child; (4) grandchild; (5) brother, (6) sister; (7) aunt; (8) uncle; (9) first cousin; (10) nephew or niece. This includes adopted, in-law and step-relatives. 16-SD-C-01 Page9

2. DEFINITIONS Family Status Change means one of the following events: · your marriage or divorce; · the birth of your child; · the adoption of a child by you; · the placement of a child with you, pending adoption; · the death of your Spouse or child; · the commencement or termination of employment of your Spouse. Initial Enrollment means the first date you are eligible to enroll for Employee Insurance, Spouse Insurance and Dependent Children Insurance. Injury means unintentional physical damage or harm caused directly by an accident and not due to sickness, disease or any other causes. Insurance Amount means the amount of insurance available under the Policy as shown in the Benefit Highlights and for which a person covered under the Policy is insured. Insured means any person covered under the Policy. Intoxicated means: · under the influence of alcohol, illegal drugs or prescription drugs other than as prescribed by your Physician; or · at or above the minimum blood alcohol level for which you would be considered operating a motorized vehicle under the influence of alcohol in the jurisdiction where the Intoxication occurred. For the purposes of this definition, "operating" includes allowing the engine to run even if not seated in the vehicle and "motorized vehicle" includes, but is not limited to, automobiles, motorcycles, boats and snowmobiles. Late Entrant means you apply for any insurance more than 90 days after you first become eligible to enroll in it. Layoff means that you are temporarily not Actively at Work for a period of time your Employer agreed to in Writing. Your normal vacation time is not considered a temporary Layoff. Leave of Absence means that you are temporarily not Actively at Work for a period of time your Employer agreed to in Writing. Your normal vacation time is not considered a temporary Leave of Absence. Nationally Recognized Authorities means the American Medical Association (AMA) Council on Scientific Affairs, the AMA Diagnostic and Therapeutic Technology Assessment Project, the AMA Board of Medical Specialties, the American College of Physicians and Surgeons, the Food and Drug Administration, the Centers for Disease Control and Prevention, the Office of Technology Assessment, the National Institutes of Health, the Health Care Finance Administration, the Agency for Health Care Policy and Research, the Department of Health and Human Services, the National Cancer Institute, and any additional organizations we choose which attain similar status. Participation in a Riot, Rebellion or Insurrection, the words "Participation" and "Riot" in this phrase mean: Participation includes promoting, inciting, conspiring to promote or incite, aiding, abetting, and all forms of taking part in, but will not include actions taken in defense of public or private property, or actions taken in your own defense, if such actions of defense are not taken against persons seeking to maintain or restore law and order including but not limited to police officers and firefighters. 16-SD-C-01 Page10

2. DEFINITIONS Riot includes all forms of public violence, disorder, or disturbance of the public peace, by three or more persons assembled together, whether or not acting with a common intent and whether or not damage to person or property or unlawful act or acts is the intent or the consequence of such disorder. Physician means a person who is operating within the scope of his or her license and is either: · licensed in the United States or Canada as a medical doctor and authorized to practice medicine and prescribe and administer drugs or to perform surgery; or · any other duly licensed medical practitioner who is deemed by applicable state or provincial law to have the same authority as a legally qualified medical doctor. The Physician cannot be you, a business associate or any Family Member. Policy means the group insurance policy under which this Certificate is issued. Policyholder means the entity to which the Policy is issued. Proof means any medical, financial or other information that we require to make a claim determination. Signed means any symbol or method executed or adopted by a person with the present intention to authenticate a record, and which is on or transmitted by paper, electronic or telephonic media, and which is consistent with applicable law. Specialist Physician means a medical doctor who is licensed and practicing in the United States or Canada and who has completed an accredited specialty training program recognized by the American Board of Medical Specialties and has passed the examination leading to Board Certification in the field most applicable to the condition being evaluated or equivalent certification acceptable to us. Spouse means any person who is a party to a marriage and under state, federal or provincial law is recognized as a spouse or civil union partner. Spouse does not include: · any person who is insured as an Employee; or · any person residing outside the United States or Canada. This exclusion does not apply to a Spouse who resides with you while you are on a temporary work assignment outside the United States. Treatment means a Physician's consultation, care or services; diagnostic measures; or the prescription, refill or taking of prescribed drugs or medicines. We, Us, Our (we, us, our) means Sun Life Assurance Company of Canada. Written or Writing means a record which is on or transmitted by paper, electronic or telephonic media, and which is consistent with applicable law. You, Your (you, your) means an Employee who is eligible for insurance under the Policy. 16-SD-C-01 Page11

3. ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF EMPLOYEE INSURANCE When are you eligible for Employee Critical Illness Insurance? You are initially eligible for Employee Critical Illness Insurance on the latest of: · January 1, 2019; · your first day of employment; or · the date you first are Actively at Work in an Eligible Class. You are also eligible for Employee Critical Illness Insurance during any Enrollment Period or as a result of a Family Status Change, provided you are Actively at Work and in an Eligible Class. When must you enroll for Employee Critical Illness Insurance? You must enroll within 90 days of the date you are initially eligible for Employee Critical Illness Insurance otherwise you will be considered a Late Entrant. If you refuse your insurance or do not enroll when you are eligible, then you will not be allowed to enroll until the next Enrollment Period or until a Family Status Change. When does your Employee Critical Illness Insurance start? For Contributory Employee Critical Illness Insurance, your insurance starts on the later of the date: · you are eligible; or · you enroll and agree to make any required contribution toward the cost of insurance; and you are Actively at Work on that date. If you are not Actively at Work on that date, your insurance will not start until you resume being Actively at Work. When can you make changes in Employee Critical Illness Insurance? You may request a change in your Employee Critical Illness Insurance Amount or benefit elections during any Enrollment Period after you are covered under the Policy and Actively at Work. You may also request a change in Employee Critical Illness Insurance at any time due to a Family Status Change. Such request must be made within 31 days of the date the Family Status Change occurred. Any amount or increase in Employee Insurance is subject to the Pre-Existing Conditions limitation. A pre- existing condition will be considered to have occurred in relation to the effective date of the change, not the original effective date of your coverage. You may only increase or decrease your Employee Insurance Amount within the limits shown in the Benefit Highlights. When does a change in Employee Critical Illness Insurance start? If you are Actively at Work, any increase in Employee Critical Illness Insurance or benefits, for reasons other than a Family Status Change, will start on the January 1st following the date of change, when you apply for a different coverage option and you agree to make any required contribution toward the cost of insurance. If you are not Actively at Work on that date, any increase in Employee Critical Illness Insurance will not start until you resume being Actively at Work. Whether or not you are Actively at Work, any reduction in Employee Critical Illness Insurance or benefits, for reasons other than a Family Status Change, will start on the January 1st following the date of change, when you apply for a different coverage option. 16-SD-C-01 Page12

3. ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF EMPLOYEE INSURANCE If you are Actively at Work, any increase in insurance or benefits due to a Family Status Change will start on the latest of: · the date you apply for such change in Employee Critical Illness Insurance, if you apply within 31 days of the Family Status Change and you agree to make any required contribution toward the cost of insurance; or · the date of your Family Status Change. If you are not Actively at Work on that date, any increase due to a Family Status Change in Employee Critical Illness Insurance or benefits will not start until you resume being Actively at Work. Whether or not you are Actively at Work, any reduction in Employee Critical Illness Insurance or benefits due to a Family Status Change will start on the date of your Family Status Change. Any change is subject to all the terms of the Policy. When does Employee Critical Illness Insurance end? Your Employee Critical Illness Insurance under the Policy will end on the earliest of the following to occur: · the date the Policy terminates; · the last day of the period for which any required premium has been paid for your Employee Critical Illness Insurance or any part of your insurance; · the date you request in Writing to cancel your Employee Critical Illness Insurance; · the date all benefits paid or payable for you under the Policy reach the maximum amount payable as described herein; or · the date you die. Your Employee Critical Illness Insurance will also end when any of the following occur, but coverage may be extended subject to any allowed continuation as specified in the Insurance Continuation section: · the date you are no longer in an Eligible Class; · the date you enter active duty in any armed service; · the date you retire; · the date your class is no longer included for insurance; or · the last day you are Actively at Work, subject to any applicable Portability provision provided. If your coverage has ended, can it be reinstated? If your insurance ends for any reason other than you have voluntarily terminated your insurance, then your insurance may be reinstated within 12 months from when your insurance ended. To reinstate your insurance, you must submit a Written request within 31 days after you return to being Actively at Work in an Eligible Class. Reinstatement will be effective on the latest date when all of the following have occurred: · you agree to make any required contribution toward the cost of your insurance; and · you return to being Actively at Work. Any Diagnosis occurring between your termination date and your reinstatement effective date will not be considered a Covered Benefit. A new Eligibility Waiting Period will not apply. Your reinstated insurance will be subject to all the terms and provisions of the Policy. Coverage will not be reinstated for any amount of insurance which you continued under the Portability provision, unless you cancel such coverage. 16-SD-C-01 Page13

4. ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF SPOUSE INSURANCE When are you eligible for Spouse Critical Illness Insurance? If you are in an Eligible Class, you are initially eligible for Spouse Critical Illness Insurance on the latest of: · January 1, 2019; · the date you are eligible for Employee Critical Illness Insurance; or · the date you acquire a Spouse. You are also eligible for Spouse Critical Illness Insurance during any Enrollment Period or as a result of a Family Status Change, provided you are in an Eligible Class and have a Spouse. When must you enroll for Spouse Critical Illness Insurance? You must enroll within 90 days of the date you are initially eligible for Spouse Critical Illness Insurance otherwise you will be considered a Late Entrant. If you refuse your Spouse insurance or do not enroll when you are eligible, then you will not be allowed to enroll your Spouse until the next Enrollment Period or until a Family Status Change. When does Spouse Critical Illness Insurance start? For Contributory Spouse Critical Illness Insurance, your insurance starts on the latest of the date: · you are eligible for Spouse Critical Illness Insurance; or · you are insured under the Policy for Employee Critical Illness Insurance; or · you enroll for Spouse Critical Illness Insurance and you agree to make any required contribution toward the cost of insurance; and you are Actively at Work on that date and your Spouse is not Confined on that date. If you are not Actively at Work on that date, your Spouse Critical Illness Insurance will not start until you resume being Actively at Work. If your Spouse is Confined on the date your Spouse Critical Illness Insurance would normally start, your Spouse Critical Illness Insurance will not start until your Spouse is no longer Confined. When can you make changes in Spouse Critical Illness Insurance? You may request a change in your Spouse Insurance Amount or benefit elections during any Enrollment Period after you are covered under the Policy and Actively at Work. You may also request a change in Spouse Critical Illness Insurance at any time due to a Family Status Change. Such request must be made within 31 days of the date the Family Status Change occurred. Any amount or increase in Spouse Critical Illness Insurance is subject to the Pre-existing Conditions limitation. A pre-existing condition will be considered to have occurred in relation to the effective date of the change, not the original effective date of your coverage. You may only increase or decrease your Spouse Insurance Amount within the limits shown in the Benefit Highlights. When does a change in Spouse Critical Illness Insurance start? If you are Actively at Work, any increase in your Spouse Insurance Amount or benefits, for reasons other than a Family Status Change, will start on the January 1st following the date of change, when you apply for a different coverage option and you agree to make any required contribution toward the cost of insurance. Your Spouse must not be Confined on the date of the increase in benefits. If you are not Actively at Work on that date, any increase in Spouse Critical Illness Insurance or benefits will not start until you resume being Actively at Work. 16-SD-C-01 Page14

4. ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF SPOUSE INSURANCE If your Spouse is Confined on that date, your increase in Spouse Critical Illness Insurance or benefits will not start until your Spouse is no longer Confined. Whether or not you are Actively at Work, any reduction in Spouse Critical Illness Insurance or benefits for reasons other than a Family Status Change will start on the January 1st following the date of change, when you apply for a different coverage option. If you are Actively at Work, any increase in Spouse Critical Illness Insurance or benefits due to a Family Status Change will start on the latest of: · the date you apply for such change in Spouse Critical Illness Insurance, if you apply within 31 days of the Family Status Change and you agree to make any required contribution toward the cost of insurance; or · the date of your Family Status Change. Your Spouse must not be Confined on the date of the increase in benefits. If you are not Actively at Work on that date, any increase due to a Family Status Change in Spouse Critical Illness Insurance or benefits will not start until you resume being Actively at Work. If your Spouse is Confined on that date, your increase in Spouse Critical Illness Insurance or benefits will not start until your Spouse is no longer Confined. Whether or not you are Actively at Work, any reduction in Spouse Critical Illness Insurance or benefits due to a Family Status Change will start on the date of your Family Status Change. Any reduction in Spouse Critical Illness Insurance or benefits due to your age will start on the January 1st following the date of change, whether or not you are Actively at Work or your Spouse is Confined on the date of the decrease. When does Spouse Critical Illness Insurance end? SpouseCritical Illness Insurance under the Policy will end on the earliest of the following to occur: · the date the Policy terminates; · the last day of the period for which any required premium has been paid for your insurance or your SpouseCritical Illness Insurance or any part of your insurance or your Spouse Insurance; · the date you request in Writing to cancel your Spouse Critical Illness Insurance; · the date all benefits paid or payable for you under this Policy reach the maximum amount payable as described herein; · the date all benefits paid or payable for your Spouse under the Policy reach the maximum amount payable for your Spouse as described herein; · the date you die; or · the date your Spouse dies. Your Spouse Critical Illness Insurance will also end when any of the following occur, but coverage may be extended subject to any allowed continuation as specified in the Insurance Continuation section: · the date you are no longer in an Eligible Class; · the date you are no longer insured under the Policy; · the date your Spouse no longer meets the definition of Spouse as described in this Certificate; · the date your Spouse enters active duty in any armed service; · the date you retire; · the date your class is no longer included for insurance; or · the last day you are Actively at Work, subject to any applicable Portability provision provided. 16-SD-C-01 Page15

5. ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF DEPENDENT CHILDREN INSURANCE When are you eligible for Dependent Children Critical Illness Insurance? If you are in an Eligible Class, then you are initially eligible for Dependent Children Critical Illness Insurance on the latest of: · January 1, 2019 or; · the date you are eligible for Employee Critical Illness Insurance; or · the date you acquire your Dependent Children. You are also eligible for Dependent Children Critical Illness Insurance during any Enrollment Period or as a result of a Family Status Change, provided you are in an Eligible Class and have one or more Dependent Children. When must you enroll for Dependent Children Critical Illness Insurance? You must enroll within 90 days of the date you are initially eligible for Dependent Children Critical Illness Insurance otherwise you will be considered a Late Entrant. If you refuse your Dependent Child insurance or do not enroll when you are eligible, then you will not be allowed to enroll until the next Enrollment Period or until a Family Status Change. When does Dependent Children Critical Illness Insurance start? For Contributory Dependent Children Critical Illness Insurance, your insurance starts on the latest of the date: · you are eligible for Dependent Children Critical Illness Insurance; · you are first insured under the Policy, for Employee Critical Illness Insurance; or · you enroll for Dependent Children Critical Illness Insurance and you agree to make any required contribution toward the cost of insurance, and if you are Actively at Work on that date and your Dependent Child is not Confined on that date. If you are not Actively at Work on that date, your Dependent Children Critical Illness Insurance will not start until you resume being Actively at Work. If your Dependent Child is Confined on the date your Dependent Children Critical Illness Insurance would normally start, your Dependent Children Critical Illness Insurance for that Child will not start until your Child is no longer Confined. Confinement does not apply to a newborn child or a newly adopted child. When can you make changes in Dependent Children Critical Illness Insurance? You may request a change in your Dependent Children Insurance Amount or benefit elections during any Enrollment Period after you are covered under the Policy and Actively at Work. You may also request a change in Dependent Children Critical Illness Insurance at any time due to a Family Status Change. Such request must be made within 31 days of the date the Family Status Change occurred. Any amount or increase in Dependent Children Critical Illness Insurance is subject to the Pre-existing Conditions limitation. A pre-existing condition will be considered to have occurred in relation to the effective date of the change, not the original effective date of your coverage. You may only increase or decrease your Dependent Children Insurance Amount within the limits shown in the Benefit Highlights. When does a change in Dependent Children Critical Illness Insurance start? If you are Actively at Work, any increase in Dependent Children Critical Illness Insurance or benefits, for reasons other than a Family Status Change, will start on the January 1st following the date of change, when you apply for a different coverage option and you agree to make any required contribution toward the cost of insurance. Your Dependent Child must not be Confined on the date of the increase in benefits. 16-SD-C-01 Page16

5. ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF DEPENDENT CHILDREN INSURANCE If your Dependent Child is Confined on that date, your increase in Dependent Children Critical Illness Insurance or benefits will not start until your Dependent Child is no longer Confined. If you are not Actively at Work on that date, any increase in Dependent Children Critical Illness Insurance or benefits will not start until you resume being Actively at Work. Whether or not you are Actively at Work, any reduction in Dependent Children Critical Illness Insurance or benefits, for reasons other than a Family Status Change, will start on the January 1st following the date of change, when you apply for a different coverage option. If you are Actively at Work, any increase in Dependent Children Critical Illness Insurance or benefits due to a Family Status Change will start on the latest of: · the date you apply for such change in Dependent Children Critical Illness Insurance, if you apply within 31 days of the Family Status Change and you agree to make any required contribution toward the cost of insurance; or · the date of your Family Status Change; or · the date we approve any required Evidence of Insurability for your Dependent Child. Your Dependent Child must not be Confined on the date of the increase in benefits. If you are not Actively at Work on that date, any increase due to a Family Status Change in Dependent Children Critical Illness Insurance or benefits will not start until you resume being Actively at Work. If your Dependent Child is Confined on that date, your increase in Dependent Children Critical Illness Insurance or benefits will not start until your Dependent Child is no longer Confined. Whether or not you are Actively at Work, any reduction in Dependent Children Critical Illness Insurance or benefits due to a Family Status Change will start on the date of your Family Status Change. Any reduction in Dependent Children Critical Illness Insurance or benefits due to your age will start on the January 1st following the date of change, whether or not you are Actively at Work or your Dependent Child is Confined on the date of the decrease. How can you add a child or children to your Dependent Children Critical Illness Insurance? After you and a Dependent Child are covered under the Policy, and you are Actively at Work, any child who becomes one of your Dependent Children will automatically be covered. How does Dependent Children Critical Illness Insurance apply to newborn children, newly placed foster children or newly adopted children? If you are insured under the Policy but do not have Dependent Children Critical Illness Insurance when a newborn child, newly placed foster child or newly adopted child becomes one of your Dependent Children, then such child will automatically be covered for 31 days from the date he or she becomes your Dependent Child. To continue coverage beyond 31 days, you must: · enroll for Dependent Children Critical Illness Insurance within 31 days from the date the newborn child, newly placed foster child or newly adopted child becomes your Dependent Child; and · pay the required premium to continue your Dependent Children Critical Illness Insurance. If you are covered under the Policy and have Dependent Children Critical Illness Insurance when a newborn child, newly placed foster child or newly adopted child becomes one of your Dependent Children, then such child will automatically be covered. When does Dependent Children Critical Illness Insurance end? Dependent Children Critical Illness Insurance under the Policy will end on the earliest of the following to occur: 16-SD-C-01 Page17

5. ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF DEPENDENT CHILDREN INSURANCE · the date the Policy terminates; · the last day of the period for which any required premium has been paid for your insurance or your Dependent Children Critical Illness Insurance or any part of the insurance; · the date you request in Writing to cancel your Dependent Children Critical Illness Insurance; · the date all benefits paid or payable for you under this Policy reach the maximum amount payable as described herein; · the date all benefits paid or payable for a specific Dependent Child reach the maximum amount payable as described herein; · the date you die; or · the date your Dependent Child dies. Your Dependent Children Critical Illness Insurance will also end when any of the following occur, but coverage may be extended subject to any allowed continuation as specified in the Insurance Continuation section: · the date you are no longer in an Eligible Class; · the date you are no longer insured under the Policy; · the date your Dependent Child no longer meets the definition of Dependent Child as described in this Certificate, but only with respect to that person; · the date your Dependent Child enters active duty in any armed service; · the date you retire; or · the date your class is no longer included for insurance; or · the last day you are Actively at Work, subject to any applicable Portability provision provided. 16-SD-C-01 Page18

6. BENEFIT PROVISIONS What benefits are payable? We will pay you a lump-sum benefit for the insurance in force when any eligible Insured, on or after the effective date of insurance, is Diagnosed with a Critical Illness condition as defined in the Covered Conditions section of this Certificate. Any benefits payable are subject to the limitations, exclusions and other conditions stated in the Policy. How is the amount of the benefit determined? We will multiply the Insured’s Insurance Amount by the Benefit Percentage for the applicable Covered Condition as shown in the Benefit Highlights to determine the benefit to be paid. If benefits for a particular Critical Illness have been paid, an Insured is not eligible for any additional benefits if the Insured is ever Diagnosed with that Critical Illness again except as described in Recurrence Benefit. If an Insured is Diagnosed with more than one Critical Illness on the same date, we will pay only the benefit for the Critical Illness with the largest Benefit Percentage. Additional Occurrence When is an additional benefit payable? If we pay benefits for a particular Critical Illness, we will pay benefits for a different Critical Illness listed in the Benefit Highlights, if there are more than 6 consecutive months between Diagnoses. Recurrence Benefit When is a Recurrence Benefit payable? We will pay a Recurrence Benefit, as shown in the Benefit Highlights, if: · benefits have been paid under this Policy because an Insured was Diagnosed with a Critical Illness; and · an Insured is Diagnosed with the same Critical Illness more than 12 consecutive months later; and · the Insured has not received Treatment for the same Critical Illness for 12 consecutive months after the Diagnosis for the Critical Illness. For the purposes of this provision, we will not consider follow-up visits to a Physician or prescription medications other than cytotoxic medications (cancer chemotherapy) to be Treatment. How is the amount of the Recurrence Benefit determined? We will multiply the Insured’s Insurance Amount by the Recurrence Benefit Percentage for the applicable Covered Condition as shown in the Benefit Highlights to determine the benefit to be paid. What is the maximum benefit payable under the Recurrence Benefit? We will pay the Recurrence Benefit for an Insured only once for each applicable Covered Condition. 16-SD-C-01 Page19

7. COVERED CONDITIONS What Critical Illness conditions are covered? The Critical Illness conditions listed below are covered under the Policy. CORE CONDITIONS CATEGORY Heart Attack means, that while insured under the Policy, the Insured has been Diagnosed with Coronary Artery Disease that results in the death of heart muscle due to acute obstruction of a coronary artery that results in a rise and fall of biochemical cardiac markers to levels considered diagnostic of myocardial infarction and includes at least one of the following: · heart attack symptoms; or · new electrocardiogram (ECG) changes consistent with a Heart Attack. The Diagnosis of Heart Attack must be made by a Specialist Physician. Exclusions: Heart Attack does not include: · elevated biochemical cardiac markers as a result of an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty; or · silent myocardial infarction, including ECG or imaging changes suggesting a prior myocardial infarction, which do not meet the Heart Attack definition as described above. Stroke means, that while insured under the Policy, the Insured has been Diagnosed with cerebrovascular disease resulting in a brain tissue infarction or hemorrhage documented by brain imaging in association with acute onset of new neurologic deficits consistent with central nervous system damage. The Diagnosis of Stroke must be made by a Specialist Physician. Exclusions: For the purposes of this Policy, Stroke does not include: · Transient Ischemic Attacks (TIAs); · Transient Global Amnesia (TGA); or · External trauma causing Injury to the brain. Major Organ Failure means, that while insured under the Policy, the Insured is Diagnosed with any end- stage disease as specified by the most current edition of the International Classification of Diseases (ICD) of the heart, liver, lung, small intestine, pancreas or bone marrow that has resulted in the chronic and irreversible failure of the organ to function. For all organs listed above, a transplant is recommended as soon as an appropriate donor is located, and the Insured is either registered with the: · United Network of Organ Sharing (UNOS); or · National Marrow Donor Program (NMDP). The Diagnosis of Major Organ Failure must be made by a Specialist Physician. Exclusions: Major Organ Failure does not include any of the following: · bone marrow failure that results from the Treatment process for cancer; · failure of any other organ not listed above; or · a transplant in which the Insured’s own bone marrow is used. If multiple organs are to be replaced at the same time, only one benefit for Major Organ Failure is payable. End-Stage Kidney Disease means, that while insured under the Policy, the Insured has been Diagnosed with a renal disease that has resulted in either: 16-SD-C-01 Page20

7. COVERED CONDITIONS · the chronic and irreversible failure of both kidneys to function and which requires regular dialysis for a minimum of 90 days; or · the need for a kidney transplant. The Diagnosis of End-Stage Kidney Disease must be made by a Specialist Physician. In the event a kidney is transplanted at the same time as other organs, only one benefit is payable. Occupational Infectious Disease means, that while insured under the Policy, the Insured is Diagnosed with Human Immunodeficiency Virus (HIV) infection or Hepatitis B, C and/or D resulting from accidental exposure to HIV or Hepatitis B, C and/or D by contaminated body fluids during the course of performing the Insured’s regular occupation for which remuneration is earned. To prove occupational exposure, all of the following must be submitted: · documentation showing that within five days of the accidental exposure, the exposure was reported and recorded by the appropriate person according to legislation, regulations or standard guidelines that apply to the occupation; · a negative antibody for HIV or Hepatitis B, C and/or D test, performed by a state certified and licensed laboratory within five days of exposure; and · a positive antibody for HIV or Hepatitis B, C and/or D test, taken in the 90 to 180 days following the exposure. Occupational Infectious Disease does not include HIV or Hepatitis B, C and/or D that occurs as a result of IV drug use, sexual transmission or is determined not to be accidental. The Diagnosis of Occupational Infectious Disease must be made by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of Occupational Infectious Disease must occur while insured under the Policy. Coronary Artery Bypass Graft means, that while insured under the Policy, an Insured has been Diagnosed with Coronary Artery Disease requiring a procedure to bypass one or more diseased, narrowed or blocked coronary arteries with arterial or venous grafts and is performed by a board certified cardiovascular surgeon. Exclusions: No benefit will be payable for diseases requiring other procedures such as percutaneous transluminal coronary angioplasty (PTCA) or laser procedures. Angioplasty means, that while insured under the Policy, the Insured has been Diagnosed with Coronary Artery Disease requiring a procedure to correct the narrowing or blockage of one or more coronary arteries by balloon. Angioplasty does not include a laser based intra-arterial procedure. CANCER CONDITIONS CATEGORY Invasive Cancer means, that while insured under the Policy, the Insured has been Diagnosed with a malignant neoplasm, which is characterized by the uncontrolled growth and spread of malignant cells and the invasion of neighboring tissue. The Diagnosis must be: · made by a Specialist Physician; and · supported by pathological confirmation or its equivalent. A Clinical Diagnosis will be accepted only if a pathological confirmation of the Diagnosis cannot be made because it is medically inappropriate or life threatening. 16-SD-C-01 Page21

7. COVERED CONDITIONS Exclusions: No benefit will be payable for the following: · lesions described as benign, pre-malignant, uncertain, borderline, non-invasive, carcinoma in-situ (Tis), or tumors classified as Ta; · malignant melanoma skin cancer that is less than or equal to 1.0 mm in thickness, unless it is ulcerated or is accompanied by lymph node or distant metastasis; · any non-melanoma skin cancer, without lymph node or distant metastasis; · early prostate cancer classified as T1a or T1b (or equivalent staging) without lymph node or distant metastasis; or · thyroid cancer less than or equal to 1.0 cm in greatest diameter and classified as T1, without lymph node or distant metastasis. No benefit will be payable under this provision for the cancers listed in the Non-Invasive Cancer provision below. No benefit will be payable for a recurrence or metastasis of an original cancer which was Diagnosed prior to the effective date of insurance. Non-Invasive Cancer means, that while insured under the Policy, the Insured has been Diagnosed with a cancer wherein the tumor cells still lie within the tissue of origin without having invaded neighboring tissue. The Diagnosis must be: · made by a Specialist Physician; and · supported by pathological confirmation or its equivalent. A Clinical Diagnosis will be accepted only if a pathological confirmation of the Diagnosis cannot be made because it is medically inappropriate or life threatening. Non-Invasive Cancer includes, but is not limited to: · chronic lymphocytic leukemia that has not progressed beyond Rai stage 0; · Stage 1A (T1a) malignant melanoma (melanoma less than or equal to 1.0 mm in thickness, not ulcerated and without Clark level IV or level V invasion); · early prostate cancer Diagnosed as T1a or T1b, or equivalent staging without lymph node or distant metastasis; · thyroid cancer (less than or equal to 1 cm in diameter) and confined to the thyroid and classified as T1a, without lymph node or distant metastasis; and · ductal carcinoma in situ (DCIS) of the breast. Exclusions: Non-Invasive Cancer does not include any of the following: · pre-malignant lesions (such as intraepithelial neoplasia); · Benign tumors or polyps; · other skin cancer, such as squamous cell or basal cell cancer; or · Invasive Cancer. No benefit will be payable for a recurrence or metastasis of an original Non-Invasive Cancer which was Diagnosed prior to the effective date of insurance. Skin Cancer means, that while insured under the Policy, the Insured has been Diagnosed with basal cell cancer or squamous cell cancer of the skin. OTHER CONDITIONS CATEGORY Advanced Alzheimer’s Disease means, that while insured under the Policy, an Insured has: 16-SD-C-01 Page22

7. COVERED CONDITIONS · been initially Diagnosed with Functional Assessment Staging Scale (FAST) Stage 6 or higher for Alzheimer’s related dementia; and · demonstrated memory impairment; decreased ability to plan, organize, sequence; language disturbance; or other cognitive disturbance; and · been unable to perform 3 or more of the Activities of Daily Living without the assistance of another person. The Diagnosis of Advanced Alzheimer’s Disease must be made by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of any stage of Alzheimer’s disease must occur while insured under the Policy. Advanced Parkinson’s Disease means, that while insured under the Policy, an Insured has: · been initially Diagnosed with primary idiopathic Parkinson’s disease at stage 4 or higher on the Hoehn and Yahr scale; and · demonstrated resting tremor, rigidity, bradykinesia and dementia despite a generally accepted drug regimen; and · been unable to perform 3 or more of the Activities of Daily Living without the assistance of another person. The Diagnosis of Advanced Parkinson’s Disease must be made by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of any stage of Parkinson’s disease must occur while insured under the Policy. Advanced ALS or Lou Gehrig’s Disease means, that while insured under the Policy, the Insured has: · been initially Diagnosed with definite amyotrophic lateral sclerosis (ALS) according to criteria established by the World Federation of Neurology; and · been determined to require either a feeding tube or non-invasive ventilation; and · been unable to perform 3 or more of the Activities of Daily Living without the assistance of another person. The Diagnosis of Advanced ALS or Lou Gehrig’s Disease must be made by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of any stage of amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s Disease must occur while insured under the Policy. Benign Brain Tumor means, that while insured under the Policy, the Insured is initially Diagnosed with a non-malignant tumor located in the cranial vault and limited to the brain, meninges, or cranial nerves or pituitary gland. The tumor must require surgical or radiation Treatment or cause irreversible objective neurological deficit(s). The Diagnosis of Benign Brain Tumor must be made by a Specialist Physician. Exclusions: No benefit will be payable for the following: · hematomas, cysts or granulomas; or · intracranial malformations of the arteries or veins; or · pituitary tumors, spine or cranial nerves, including pituitary adenomas less than 10 mm. in diameter, acoustic neuroma or craniopharyngioma. The Diagnosis of Benign Brain Tumor must be made by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of Benign Brain Tumor must occur while insured under the Policy. No benefit will be payable for a recurrence or metastasis of an original tumor which was Diagnosed prior to the effective date of insurance. CompleteBlindness means, that while insured under the Policy, the Insured has been initially Diagnosed with an irreversible reduction in sight lasting at least 180 days, that results in a corrected visual acuity of 20/400 or less or a visual field less than 20 degrees when testing both eyes together. 16-SD-C-01 Page23

7. COVERED CONDITIONS Benefits for Complete Blindness are not payable if the condition is a consequence of another condition for which another Critical Illness benefit has been paid. The Diagnosis of Complete Blindness must be made by a Specialist Physician. Coma means a Diagnosis, while insured under the Policy, of a state of unconsciousness with no reaction to external stimuli and which requires an external life support system, both of which have persisted continuously for at least 168 hours. The Diagnosis of Coma must be made by a Specialist Physician. Exclusions: Coma does not include medically induced coma. Complete Loss of Hearing means, that while insured under the Policy, the Insured has been initially Diagnosed with a condition that results in the total and irreversible loss of hearing in both ears to a point that an Insured is unable to hear sounds at or below 70 decibels. The Diagnosis must be confirmed using audiometric testing. Complete Loss of Hearing does not include loss of hearing that can be corrected to above 70 decibels by the use of any hearing aid or device. Benefits for Complete Loss of Hearing are not payable if the condition is a consequence of another condition for which another Critical Illness benefit has been paid. The Diagnosis of Complete Loss of Hearing must be made by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of Complete Loss of Hearing must occur while insured under the Policy. Loss of Speech means, that while insured under the Policy, the Insured is initially Diagnosed with total, permanent and irreversible loss of the ability to speak. The loss must: · be as a result of Injury or sickness affecting the speech organs; and · have continued without interruption for a period of at least six (6) consecutive months. Loss of Speech does not include any loss that could be restored, totally or partially, by use of a device or implant. Benefits for Loss of Speech are not payable if the condition is a consequence of another condition for which another Critical Illness benefit has been paid. The Diagnosis of Loss of Speech must be made by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of Loss of Speech must occur while insured under the Policy. Paralysis means, that while insured under the Policy, the Insured has been Diagnosed with total and irreversible loss of use of two or more limbs due to Injury of the spinal cord and that is continuously present for a period of at least 180 days. Limb is defined as the complete arm or the complete leg. The Diagnosis of Paralysis must be made by a Specialist Physician and shall not include any impairment caused by a Stroke or other sickness. Severe Burns means, that while insured under the Policy, the Insured is initially Diagnosed with third- degree burns over at least 18% of the body surface. Severe Burns must occur while the Insured’s insurance is in force to be eligible for a benefit. The Diagnosis of Severe Burns must be made by a Specialist Physician. CHILDHOOD CONDITIONS CATEGORY The following covered childhood conditions apply only to children who meet the definition of Dependent Children and are insured under this Certificate: Cerebral Palsy means a Diagnosis of nonprogressive, neurological defect affecting muscle control resulting from an Injury to or congenital abnormality. The initial Diagnosis of Cerebral Palsy must be made 16-SD-C-01 Page24

7. COVERED CONDITIONS by a Specialist Physician supported by abnormal brain imaging (MRI or equivalent) while your Dependent Child is under the age of 5 and insured under the Policy. Exclusions: No benefit will be payable for the following: · Autism-as primary Diagnosis; and · motor deficits due to an underlying medical condition (syndrome, genetic or hereditary condition). Cleft Lip/Palate means that your covered Dependent Child under the age of 18 has been initially Diagnosed with either a cleft lip or a cleft palate. A Cleft Lip means a congenital failure of the upper lip to close and results in a narrow gap in the upper lip that extends to the nostril on one side or both sides of the mouth. A Cleft Palate means a congenital failure to close an opening in the roof of the mouth that extends to the nasal cavity. When a combination of Cleft Lip and Cleft Palate is Diagnosed, only one Diagnosis is eligible for benefits. The Diagnosis of Cleft Lip/Palate must be made by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of Cleft Lip/Palate must occur while insured under the Policy. Complex Congenital Heart Disease means your covered Dependent Child under the age of 18 has been initially Diagnosed with at least one of the following covered heart conditions: · coarctation of the aorta; · Ebstein's anomaly; · Eisenmenger syndrome; · Tetralogy of Fallot; · transposition of the great vessels; or · any other congenital cardiac condition that requires open heart surgery. The Diagnosis of Complex Congenital Heart Disease must be made and the surgery must be recommended by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of Complex Congenital Heart Disease must occur while insured under the Policy. Cystic Fibrosis means evidence of a lung disease that your covered Dependent Child under the age of 18 has been initially Diagnosed with by a Specialist Physician while insured under the Policy. The Diagnosis must be confirmed with sweat chloride tests and genetic testing. Exclusions: Cystic Fibrosis does not include the following: · asymptomatic; · clinical features limited to CABVD (congenital absence of vasdeferens); or · gastrointestinal issues. The Diagnosis of Cystic Fibrosis must be made by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of Cystic Fibrosis must occur while insured under the Policy. Type 1 Diabetes Mellitus means that your covered Dependent Child under the age of 18 has been initially Diagnosed with a chronic autoimmune, genetic or infectious destruction of the insulin producing cells in the pancreas and that requires continuous, lifelong insulin therapy. The Diagnosis of Type 1 Diabetes Mellitus must be made by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of Type 1 Diabetes Mellitus must occur while insured under the Policy. Down Syndrome means that your covered Dependent Child under the age of 18 has been initially Diagnosed with Down Syndrome by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of Down Syndrome must occur while insured under the Policy. 16-SD-C-01 Page25

7. COVERED CONDITIONS Muscular Dystrophy means your covered Dependent Child under the age of 18 has been initially Diagnosed with either Duchenne muscular dystrophy or Becker muscular dystrophy by specific testing. Clinical evidence of neuromuscular features of muscular dystrophy must be present. The Diagnosis must be made by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of Muscular Dystrophy must occur while insured under the Policy. Spina bifida means that your covered Dependent Child under the age of 18 has been initially Diagnosed with congenital conditions of meningocele or myelomeningocele. Spina Bifida does not include spina bifida occulta. The Diagnosis must be made by a Specialist Physician and be associated with neurologic symptoms including motor impairment identified by a Specialist Physician. In order for a benefit to be paid, the initial Diagnosis of Spina Bifida must occur while insured under the Policy. 16-SD-C-01 Page26

8. EXCLUSIONS AND LIMITATIONS What exclusions apply to the benefits payable? In addition to the exclusions stated in the Covered Conditions section of this Certificate, we will not pay any benefit that is caused by, contributed to in any way, or resulting from any Critical Illness condition Diagnosed outside the United States or Canada without confirmation of the Diagnosis by the type of Specialist Physician specified for each of the Covered Conditions in Section 7 who practices in the United States or Canada. We will not pay a benefit for any Critical Illness that is due to or results from: · services or Treatment not included in the Benefit Highlights; · services or Treatment provided by a Family Member; · Treatment or complications of Treatment not related to a Critical Illness; · an autologous bone marrow transplant, one in which your own bone marrow is used; · intentionally self-inflicted injuries; · elective plastic or cosmetic surgery; · active military duty; · war or any act of war or your active duty in any armed service during a time of war (this does not include acts of terrorism); · your active Participation in a Riot, Rebellion or Insurrection; · committing or attempting to commit an assault, felony or other criminal act; · your engagement in dangerous conduct or hazardous activity where there is a likelihood of death or serious Injury; · committing or attempting to commit suicide, whether sane or insane; · incarceration in a penal institution of any kind; or · being legally Intoxicated or under the influence of any narcotic unless taken on the advice of a Physician and taken as prescribed. What limitations apply to the benefits payable? In addition to the limitations stated in the Covered Conditions section of this Certificate, we will not pay any benefit for any Critical Illness that is Diagnosed in the first 12 months following the effective date of any Insured’s insurance and results from a Pre-Existing Condition. Pre-Existing Condition means during the 6 months prior to any Insured’s effective date of insurance or the effective date of an increase in any Insured’s amount of insurance, any condition for which any Insured: · sought medical Treatment, consultation, advice, care or services, including diagnostic measures for the condition or symptoms related to the condition, regardless of whether the condition was Diagnosed or suspected at that time; or · took prescribed drugs or medicines for the condition. When newborn children, newly placed foster children or newly adopted children are added to your Dependent Children Insurance within 31 days of the birth, placement or adoption, the Pre-Existing Condition limitation does not apply. 16-SD-C-01 Page27

9. WELLNESS SCREENING BENEFIT What is the wellness screening benefit? While your insurance under the Policy is in force, we will pay you a wellness screening benefit each Benefit Year during which you or your insured Spouse or your insured Dependent Child has any one of the following wellness screening tests performed: · CA15-3 (blood test for breast cancer) · Breast Cancer Screening (clinical breast exam, mammography, MRI, thermography, ultrasound) · CA 125 (blood test for ovarian cancer) · Colorectal Cancer Screening (fecal occult blood test, colonoscopy, sigmoidoscopy) · CEA (blood test for colon cancer) · Lipid panel (cholesterol, triglycerides, HDL, LDL) · Pap smear · Prostate Cancer Screening (digital rectal exam, PSA blood test) · Skin Cancer Screening · Diabetes tests (fasting blood glucose test, hemoglobin A1c) · Cardiac exercise stress test · Electrocardiogram (ECG)-resting or stress · Chest x-ray · Hemocult stool analysis · Serum protein electrophoresis · Carotid Doppler · Echocardiogram · Immunizations · Interscholastic Sports Physical Exam What is the amount of the wellness screening benefit? We will pay you the amount as shown in the Benefit Highlights once each Benefit Year if any one of the wellness screening tests described in this Certificate is performed for you regardless of the results of the test. We will pay you the amount as shown in the Benefit Highlights once each Benefit Year if any one of the wellness screening tests described in this Certificate is performed for your insured Spouse. We will pay you the amount as shown in the Benefit Highlights once each Benefit Year if any one of the wellness screening tests described in this Certificate is performed for your insured Dependent Child. The wellness screening benefit is paid in addition to any other benefits payable under the Policy. What conditions apply to the wellness screening benefit? To receive this benefit, you must notify us of which wellness screening test was performed. 16-SD-C-01 Page28

10. CLAIM PROVISIONS How is a claim submitted? To submit a claim, you or someone on your behalf must send us Written notice and Proof of claim on our form within the time limits specified. Your Employer has the notice and Proof of claim forms. NOTICE OF CLAIM When does Written notice of claim have to be submitted? Written notice of claim must be given to us no later than 90 days after the date of Diagnosis or within 180 days of the initial Treatment of the Critical Illness. If notice cannot be given within the applicable time period, we must be notified as soon as it is reasonably possible. When we receive Written notice of claim, we will send the forms for Proof of claim. If the forms are not received within 15 days after Written notice of claim is sent, Proof of claim may be sent to us without waiting to receive the Proof of claim forms. PROOF OF CLAIM When does Written Proof of claim have to be submitted? Written Proof of claim must be given to us no later than 180 days after the date of Diagnosis of the Critical Illness. If Proof cannot be given within the time limit, Proof must be given as soon as reasonably possible. Proof of claim may not be given later than one year after the time Proof is otherwise required unless the individual is legally incompetent. What is considered Proof of claim? Proof of claim must consist of at least the following information: · a description of the Critical Illness; · the date the Diagnosis occurred; · the cause of the Critical Illness; and · any other information we may require to make a claim determination. Proof of claim may include, but is not limited to, police accident reports, laboratory results, toxicology results, hospital records, x-rays, narrative reports, or other diagnostic testing materials, as required. We may require as part of the Proof, authorizations to obtain medical and non-medical information. Proof must be satisfactory to us. PAYMENT OF BENEFITS When are benefits payable? Benefits are payable upon our receipt of satisfactory Proof of claim that establishes benefit eligibility according to the provisions of the Policy. When will a decision on your claim be made? Claims that are not processed promptly will accrue simple interest at the rate required by Indiana law. Under a clean claim, interest will accrue from: · the 46th day we receive first proof of claim in writing; or · the 31st day after we receive the first proof of claim by electronic means. A claim is considered "clean" when the first proof of claim is complete; no part of the claim is contested; and no other defect prevents prompt payment. A claim will also be considered "clean" when we fail to 16-SD-C-01 Page29

10. CLAIM PROVISIONS promptly request more information or to resolve it, within 45 days after receiving a written claim or 30 days after receiving an electronic claim. Under a defective claim, interest will accrue from: · the 46th day after receipt of enough proof to confirm liability, if the claim is filed in writing and we request more information within 45 days; or · the 31st day after we receive enough proof to confirm liability, if the claim is filed by electronic means and we request more information within 30 days. A claim is considered "defective" when the first proof of claim is incomplete; any part of the claim is contested; or some other defect prevents prompt payment. What if your claim is denied? If we deny all or any part of your claim, you will receive a Written notice of denial stating: · the specific reason(s) for the denial; · the specific Policy provision(s) on which the denial is based; · your right to receive, upon request and free of charge, copies of all documents, records, and other information relevant to your claim for benefits; · a description of any additional material or information needed to prove entitlement to benefits and an explanation of why such material or information is necessary; · a description of the appeal procedures and time limits; · your right to bring a civil action under ERISA, §502(a), if applicable, following an adverse determination on review; and · the identity of any medical or vocational experts whose advice was obtained in connection with the claim, regardless of whether the advice was relied upon to deny the claim. Can you request a review of a claim denial? If all or part of your claim is denied, you may request in Writing a review of the denial within 60 days after receiving notice of denial. You may submit Written comments, documents, records or other information relating to your claim for benefits, and may request free of charge copies of all documents, records, and other information relevant to your claim for benefits. We will review the claim on receipt of the Written request for review, and will complete our review within 20 business days from the date we receive your request and all information needed to complete the review 60 days after the request has been received. If an extension of time is required to process the claim, we will notify you in Writing of the special circumstances requiring the extension and the date by which we expect to make a determination on review. The extension cannot exceed a period of 10 business days from the end of the initial period. We will notify you in writing of our decision within 5 business days after our investigation is complete. If a period of time is extended because you failed to provide information necessary to decide your claim, the period for making the decision on review is tolled from the date we send notice of the extension to you until the date on which you respond to the request for additional information. You will have at least 45 days to provide the specified information. What if your claim is denied on review? If we deny all or any part of your claim on review, you will receive a Written notice of denial stating: · the specific reasons for the denial; · the specific Policy provisions and reasons on which the denial is based; · your right to appeal the decision and information regarding the department or person to contact for information about the decision and your right to appeal; · your right to receive, upon request and free of charge, copies of all documents, records, and other information relevant to your claim for benefits; · your right to bring a civil action under ERISA, §502(a), if applicable; and 16-SD-C-01 Page30

10. CLAIM PROVISIONS · the following statement: “You and your plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State Insurance regulatory agency.” What is the procedure to file a grievance? A grievance or complaint is an expression of dissatisfaction regarding the handling or payment of claims, matters pertaining to the contractual relationship between you and us, or our decision to rescind this Certificate. You or your designee may submit a grievance verbally or in writing. Upon receipt of the grievance, the following steps will be taken: · We will acknowledge the grievance within 5 business days upon receipt. We will document the substance of the grievance and any actions taken. We will investigate the substance of the grievance, and after acquiring all information reasonably necessary to complete the review, we will make a decision regarding the grievance within 20 business days. If we are unable to make a decision regarding the grievance within the 20 business day period due to circumstances beyond our control, we will notify you in writing of the reason for the delay and issue a written decision regarding the grievance within an additional 10 business days. We will notify you in writing within 5 business days of reaching a resolution of the grievance. In that notice, we will: · provide a statement of the decision reached by us; · provide a statement of the reasons, policies, and procedures that are the basis of the decision; · provide you with notice of your right to appeal the decision; · provide you with the department, address, and telephone number where to contact a qualified representative to obtain additional information. Should you not agree with the decision, you have a right to appeal the grievance resolution. The appeal process is as follows: · We will issue a written or oral acknowledgment of the appeal no more than 5 business days after the appeal is filed. We will document the substance of the appeal and any actions taken. We will investigate the substance of the appeal and a decision will be made within 45 days after the filing of the appeal. We will notify you in writing within 5 business days of reaching a resolution of the appeal. In that notice, we will: · provide a statement of the disposition of the appeal; · provide a statement of the reasons, policies, and procedures that are the basis of the decision; · provide you with notice of the right to further remedies allowed by law, including the right to initiate an external grievance review by an independent review organization; · provide you with the department, address, and telephone number where to contact a qualified representative to obtain additional information. In situations where you do not agree with the decision of the appeal, you may have the right to further remedies allowed by the law, including the right to an external grievance review by an independent review organization. You will have no more than 120 days after you are notified of the appeal resolution to file a written request with us for an external grievance review. Upon receipt of the written request, the following steps will be taken: · We will select a different independent review organization for each filed external grievance, from the list of independent review organizations certified by the Indiana Department of Insurance. · We will rotate the choice of an independent review organization among all certified independent review organizations before repeating a selection. · The independent review organization shall make a determination to uphold or reverse our appeal resolution within 15 business days after the external grievance is filed. · The independent review organization shall notify you and us of the determination made of a standard external grievance within 72 hours after making the determination. In instances of 16-SD-C-01 Page31

10. CLAIM PROVISIONS expedited external grievances, the independent review organization shall notify you and us of the determination made within 72 hours after the external grievance is filed. Such determination is binding on us. You shall not pay any of the costs associated with the services of an independent review organization. Should you submit information to us that is relevant to the resolution of the appeal of the grievance, and was not previously considered or reviewed by us: · We may reconsider the prior resolution. If we elect to reconsider, the independent review organization shall cease the external review process until the reconsideration is completed. · We shall notify you of a decision within 72 hours after the information is submitted, for a reconsideration, if making a decision in the standard timeline would seriously jeopardize the Insured’s life or health, or his or her ability to reach and maintain maximum function. · Under any other circumstances, we shall notify you within 15 days after the information is submitted. · If you do not agree with our decision, you may request that the independent review organization resume the external review process. · If we choose to not reconsider our initial resolution after receipt of the relevant new information, we shall forward such submitted information to the independent review organization not more than 2 business days after we receive it. Documents and other information created or received by the independent review organization or the medical review professional in connection with an external grievance review are not considered public records to which access is granted and will be treated in accordance with confidentiality requirements of state and federal law. · An independent review organization is immune from civil liability for actions taken in good faith in connection with an external review and its work product and/or determination are admissible in a judicial or administrative proceeding. However, the work product and/or determination do not, without other supporting evidence, satisfy a party’s burden of proof or persuasion concerning any material issue of fact or law. If you have the right to an external review of a grievance under Medicare, you may not request an external review of the same grievance under this process. Pursuing a resolution through the grievance process does not add to or otherwise change the terms of coverage included in this Policy. For further information, you may contact us at the phone number or address listed on the front cover of this Certificate. To whom are benefits payable? We will pay you all benefits, if your Proof of claim is satisfactory to us, except in the following situations: · you are a minor. In such case, claim may be made by your duly appointed guardian, conservator or committee and we will pay to such person or persons; · due to physical or mental incapacity, you cannot, in our judgment, give us a valid receipt for payments. In such case, claim may be made as described above; or · you die before we pay you. In such case, claim may be made by your executor or the administrator of your estate and we will pay to such person or persons. If we do not pay you and claim is not made by the appropriate person designated above, we may, at our option, make payments under either or both Methods A or B below. Any decision to pay any benefits, prior to the appointment of the appropriate person designated (as shown above), is solely at our discretion, and we may choose to pay no amounts under any circumstances until such appropriate person is formally appointed. Method A: We may pay up to the sum of $5,000 to any individual or entity that has provided Proof of having incurred or paid expenses as a result of funeral services provided to or on your behalf. If we pay such a benefit, we will not have to pay that benefit amount again and the total benefit due under the Policy shall be reduced by the amount paid under this provision. Method B: We may pay the whole or any part of such benefit: 16-SD-C-01 Page32

10. CLAIM PROVISIONS · to your Spouse, up to a cumulative amount of $5,000; or · if you have no Spouse, up to a cumulative amount of $5,000 to any one or more of the following relatives in the following order of priority: · first, your child or children; or · then, your mother or father. 16-SD-C-01 Page33

11. INSURANCE CONTINUATION Are there any conditions under which your Employer can continue your insurance? While the Policy is in force and subject to the conditions stated in the Policy, your Employer may continue your insurance that was in force on the date immediately before the date you ceased to be Actively at Work by paying the required premium to us for any of the following reasons and durations: · absence due to Injury or sickness - up to 12 months; · Layoff – up to 3 months; · Leave of Absence - up to 3 months including Family and Medical Leave of Absences ; · School Recess – up to 3 days; · Vacation – based on your Employer’s policy, not to exceed 3 months. You should contact your Employer for more details. While the Policy is in force, you may be eligible to continue your insurance pursuant to the Family and Medical Leave Act of 1993, as amended or continue coverage pursuant to a state required continuation period (if any). You should contact your Employer for more details. While the Policy is in force, you may be eligible to continue your insurance coverage pursuant to the Uniformed Services Employment and Reemployment Rights Act (USERRA), as amended. You should contact your Employer for more details. 16-SD-C-01 Page34

12. PORTABILITY What is portable insurance and when are you eligible? Portable insurance is an optional benefit that you may elect to continue your insurance for each Insured up to the later of the day before you attain age 70 or 12 months from the date your portable insurance started if: · your insurance ends because you are no longer in an Eligible Class; or · your insurance ends because your class is no longer included for insurance; or · your insurance ends because you terminate employment; or · a revision is made to the Policy to reduce your amount of insurance; and · you meet the following requirements: · you reside in the United States or Canada; and · you have not exercised your portable insurance right under a similar certificate issued by us; and · your insurance is not being continued under any Insurance Continuation provision. You may not elect portable insurance for your Spouse or Dependent Children if you have not elected portable insurance for yourself. Your portable insurance will be provided under an insurance policy we make available for this purpose. Your portable insurance may not be identical to your current insurance under the Policy. When must you apply for portable insurance? You must complete an application for portable insurance and send it to us with payment of the first premium within 31 days of the date your insurance under the Policy terminates. The application for portable insurance and applicable rates are available from your Employer. What is the amount of portable insurance? You may apply for portable insurance in an amount up to 100% of each Insured’s remaining amount of insurance in force under the Policy on the date your insurance terminates. You may port to a lower amount of insurance if available. You cannot port to a higher amount of insurance. Your portable insurance policy will not provide any benefits beyond those described in the section of this Certificate titled Benefit Provisions. When you attain age 70, the amount of your portable insurance benefits will be reduced by 50%. When does your portable insurance start? After your insurance under the Policy terminates, your portable insurance will start on the later of the following: · the date we approve your application for portable insurance; or · the date we receive your first premium payment for portable insurance. If you are Diagnosed with a covered Critical Illness within 31 days after your insurance ends, but before you have applied to port, we will pay any benefits as if you had ported. However, you must pay any premium due. When is portable insurance available to your Spouse and when is your Spouse eligible? Portable Insurance is available for your Spouse up to the later of the day before you attain age 70 or 12 months from the date your portable insurance started if all of the following requirements are met: · you die or divorce your Spouse and your Spouse was Insured under the Policy at the time; · your Spouse resides in the United States or Canada. Your Spouse’s portable insurance will be provided under an insurance policy we make available for this purpose. Their portable insurance may not be identical to your current insurance under the Policy. 16-SD-C-01 Page35

12. PORTABILITY When must your Spouse apply for portable insurance? Your Spouse must complete an application for portable insurance and send it to us with payment of the first premium within 31 days of the date of your death or divorce. The application for portable insurance and applicable rates are available from your Employer. What is the amount of your Spouse’s portable insurance? Your Spouse may apply for portable insurance in an amount up to 100% of the remaining amount of Spouse Insurance and Dependent Children Insurance in force under the Policy on the date of your death or divorce. Your Spouse’s portable insurance policy will not provide any benefits beyond those described in the section of this Certificate titled Benefit Provisions. Your Spouse may not apply for portable insurance for a Dependent Child whose insurance has not terminated under the Policy due to divorce. When does your Spouse’s portable insurance start? After your death or divorce, your Spouse’s portable insurance will start on the later of the following: · the date we approve your Spouse’s application for portable insurance; or · the date we receive your Spouse’s first premium payment for portable insurance. 16-SD-C-01 Page36

13. GENERAL PROVISIONS AGENCY Can the Policyholder, Employer, or third party administrator act as our agent? For all purposes of the Policy, the Policyholder, Employer or third party administrator acts on its own behalf or as your agent. Under no circumstances will the Policyholder, Employer or third party administrator be deemed our agent. ALTERATION Who can alter the Policy? The only persons with the authority to alter or modify the Policy or to waive any of its provisions are our president, actuary, secretary or one of our vice presidents and any such changes must be in Writing. ASSIGNMENT Can benefit payments be assigned? You cannot assign any interest in the Policy unless we agree in Writing to such an assignment. We have the right to determine the extent to which any assignment will be honored and the priority of such assignment. We do not assume any responsibility for the validity or sufficiency of any assignment. Any payments made under such assignment after consented to by us will discharge our liabilities under the Policy, to the extent of such payments. CLERICAL ERROR What happens when there is a clerical error in the administration of the Policy? Clerical errors in the administration of the Policy or delays in keeping records for the Policy whether by us, the Policyholder, or the Employer: · will not terminate insurance that would otherwise have been effective; and · will not continue insurance that would otherwise have ceased or should not have been in effect. If appropriate, a fair adjustment of premium will be made to correct the error, subject to the "Limit of Premium Refunds" section. This provision does not apply to benefit administration errors by the Policyholder or the Employer which result in an Employee: · not enrolling for insurance within required time limits; · failing to request increased amounts of insurance within required time limits. · failing to provide any required Evidence of Insurability; or · failing to exercise any available Insurance Continuation or Portability options. CONFORMITY WITH STATUTES What is the effect of Conformity with Statutes? If any provision of the Policy conflicts with any applicable law, the provision will be automatically amended to meet the minimum requirements of the law, except as otherwise pre-empted by federal law. DISCHARGE OF OUR RESPONSIBILITY What is the effect of payments under the Policy? Payment made under the terms of the Policy will, to the extent of such payment, release us from all further obligations under the Policy. We will not be obligated to see to the application of such payment. EXAMINATION What are our examination rights? We, at our expense, have the right to have any person whose Critical Illness is the basis of a claim: 16-SD-C-01 Page37

13. GENERAL PROVISIONS · examined by a Physician, other health professional or vocational expert of our choice; and/or · interviewed by an authorized representative. This right may be used as often as we determine necessary. Unless authorized by the examining Physician, the examination may not be recorded nor may another person be present during the examination. INCONTESTABILITY What is the Incontestability Provision? Except for non-payment of premium or any claims incurred within two years of the effective date of an Insured’s initial, increased, additional or reinstated insurance, no statement made by any Insured relating to insurability for such insurance will be used to contest the validity of that insurance after the insurance has been in force for a period of two years during that individual’s lifetime. The statement must be contained in a form Signed by that individual. This provision shall not preclude the assertion at any time of a defense to a claim based upon the Insured’s eligibility for insurance. INSURER’S AUTHORITY What is our authority? Sun Life has discretionary authority to make all final determinations regarding claims for benefits under the Policy. This discretionary authority includes, but is not limited to, the right to determine eligibility for benefits and the amount of any benefits due and to construe the terms of the Policy. Any decision made by us in the exercise of this authority, including review of denials of benefit, is conclusive and binding on all parties. Any court reviewing such a decision shall uphold it unless the claimant proves that it was arbitrary and capricious. This provision applies only where the interpretation of this policy is governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. LEGAL PROCEEDINGS What are the time limits for legal proceedings? No legal action may start: · until 60 days after Proof has been given; nor · more than 3 years after the time Proof of claim is required. For claims subject to ERISA, if a claimant files state law causes of action that are later determined by a court to be preempted by ERISA, we shall be entitled to legal fees in defense of those causes of action. LIMIT OF PREMIUM REFUNDS Is there a limit on premium refunds? Whether premiums were paid in error or otherwise, we will refund only that part of the excess premium that was paid during the 12-month period that preceded the date we learned of such overpayment. MISSTATEMENT OF FACTS What happens if there is a misstatement of facts in the administration of the Policy? If relevant facts about the Employer or Employee relating to this insurance are determined not to be accurate: 16-SD-C-01 Page38

13. GENERAL PROVISIONS · a fair adjustment of premium will be made, subject to the "Limit of Premium Refunds" section; and · the actual facts will decide whether, and in what amount, and for what duration insurance is valid under the Policy. NON-PARTICIPATING Does the Policy participate in dividends? The Policy is non-participating and will not share in any profits or surplus earnings of Sun Life Assurance Company of Canada, and, therefore, no dividends are payable. PREMIUM PAYMENTS AS EVIDENCE OF INSURANCE Does the payment of premiums guarantee coverage under the Policy? The receipt of premiums by us is not a guarantee of insurance. Eligibility for benefits will be determined at the time of claim submission and in order to receive a benefit under the Policy, all Policy requirements must be satisfied. If we determine that you, your Spouse or Dependent Child are not eligible for coverage, you should contact your Employer regarding the refund of premiums due, if any. REIMBURSEMENT What if a benefit is underpaid or overpaid? Reimbursement will be made to us for any overpayments that we may make due to any reason. You must repay us within 60 days unless we agree to a longer time period. Deductions may be made from future benefit payments to recover any such overpayments. If we have underpaid a benefit for any reason, we will make a lump sum payment for that amount. Interest does not accrue on any underpaid or overpaid benefit unless required under the applicable law. STATEMENTS Are statements warranties? In the absence of fraud, all statements made in any application are considered representations and not warranties. No representation by you in enrolling for insurance under the Policy will be used to reduce or deny a claim unless a copy of your Written application for insurance is or has been given to you, your beneficiary, if any, or your estate representative. TIME PERIODS What time periods apply to this Certificate? For the purpose of effective dates and termination dates under this Certificate, all days begin at 12:00 midnight and end at 11:59:59 PM at the Policyholder’s location. 16-SD-C-01 Page39

SUN LIFE ASSURANCE COMPANY OF CANADA Group Critical Illness Insurance Certificate Non-Participating 16-SD-C-01 Page40

DePauw University Employee Benefit Plan (The Plan) has been established to provide welfare benefits for its employees. The Employee Retirement Income Security Act of 1974 (ERISA) requires that the Plan Administrator provide you with a Summary Plan Description which discloses required information about the employee benefit plan. The following section entitled "Summary Plan Description" is not part of the Group Insurance Policy. The information in the Summary Plan Description is provided by the Policyholder and is included in this Booklet/Certificate for your convenience. Sun Life Assurance Company of Canada assumes no responsibility for the accuracy or sufficiency of the information in the Summary Plan Description. SUMMARY PLAN DESCRIPTION Plan Sponsor: DePauw University 313 S Locust St Greencastle, IN 46135 Plan Administrator: DePauw University 313 S Locust St Greencastle, IN 46135 The Plan Administrator has authority to control and manage the operation and administration of the Plan. Agent for Service of Legal Process: DePauw University 313 S Locust St Greencastle, IN 46135 Employer Identification Number (EIN): 35-0869045 Plan Number: 502 End of Plan Year: December 31st Type of Administration: The Plan is administered by the Plan Administrator. The benefits provided by the Group Insurance Policy issued by Sun Life Assurance Company of Canada are included in the Plan. Participants: The insured employees described in the Sun Life Assurance Company of Canada Booklet/Certificate. Plan Changes and Termination: The Plan Administrator may amend, modify or terminate the Plan. Contributions: The cost of your benefits under the Plan is paid for by your employer and (if applicable) includes the cost of any insurance premiums contributed by you. Funding: Sun Life provides the Plan Administrator with certain insurance benefits in connection with the Plan. Those insurance benefits are described in your Booklet/Certificate. Claims Procedure: When you or your beneficiary wish to file a claim under the Plan, you should contact your personnel office for claim forms and instructions for filing. Your Booklet/Certificate explains the procedure for filing a claim under the Group Insurance Policy. If your claim for benefits is denied in whole or in part, you will receive a written notice within the time required by ERISA from the date you filed your claim, stating the reasons why your claim was denied. You will then have the right, upon written notice from you or your authorized representative, to review that claim denial. The claim denial notice will include the name and address of the person you may ask for

such a review. Additional information about claims submitted and review procedures may be obtained by contacting your Plan Administrator. Your Rights under ERISA: As a participant in the Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all plan participants shall be entitled to: Receive Information About Your Plan and Benefits · Examine, without charge, at the Plan Administrator's office and at other specified locations, such as worksites and union halls, all documents governing the Plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration. · Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The Plan Administrator may make a reasonable charge for the copies. · Receive a summary of the plan's annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report. Prudent Actions by Plan Fiduciaries In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the Plan. The people who operate your plan, called "fiduciaries" of the Plan, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a benefit or exercising your rights under ERISA. Enforce Your Rights If your claim for a benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of Plan Documents or the latest annual report from the Plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. If it should happen that Plan fiduciaries misuse the Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance of the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should pay court costs and legal fees. If you are successful the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous. Assistance with Your Questions If you have questions about your Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, DC 20210. You may also obtain certain publications

about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.