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