RL-ACC3-ADR2-23-IN 2 ADR-12967 (11/25) Dismemberment Low Plan High Plan Loss of both hands or both feet or the sight in both eyes: $16,000 $40,000 Loss of one hand or one foot AND the sight in one eye $10,000 $30,000 Loss of one hand AND one foot $10,000 $30,000 Loss of one hand OR one foot $5,000 $15,000 Loss of two or more fingers or toes $900 $2,500 Loss of one finger or toe $500 $1,500 GENERAL PROVISIONS ELIGIBILITY If you are covered under the Policy, then you are eligible for coverage under this rider on the latest of the following:  The Policy effective date.  The date coverage under this rider is available to the eligible class of Insured Persons to which you belong.  Your Accident coverage effective date. Your Spouse is eligible for coverage under this rider on the later of the date above or the date your Spouse is eligible for coverage under the Spouse Accident Rider. Your Children are eligible for coverage under this rider on the later of the date above or the date each Child is eligible for coverage under the Children’s Accident Rider. EFFECTIVE DATE Each Covered Person will be covered at 12:01 a.m. standard time at the Policyholder's address on the date the Covered Person is eligible for coverage under this rider. TERMINATION Coverage under this rider will end on the earliest of the following:  The date your Accident insurance terminates. See the PORTABILITY FOLLOWING DEATH OR DIVORCE provision below and in any riders if termination is due to death or involves coverage previously continued by your Spouse.  The date coverage under this rider is terminated for all Active Employees under the Policy. See the PORTABILITY provisions below.  The date coverage under this rider is terminated for the eligible class of Active Employees to which you belong. See the PORTABILITY provisions below.  For your Spouse’s coverage, the date your Spouse’s coverage under the Spouse Accident Rider terminates.  For each Child’s coverage, the date your Child’s coverage under the Children’s Accident Rider terminates.  The date the Policy terminates because we stop providing accident coverage to all groups in the Policy issue state and coverage for all Covered Persons under the Policy terminates. We will provide 60 days Written notice of termination. DEFINITIONS General terms defined in the DEFINITIONS section of the Certificate and riders regarding medical conditions and eligibility apply to each Covered Person. Covered Person means:  You, if you are covered for Accident insurance under the Policy.  Your Spouse if covered under the Spouse Accident Rider.  Your Children if covered under the Children’s Accident Rider.