RL-ACC3-CERT2-23-IN 7 D12967 (11/25) Skull - simple (except bones of face) $1,000/$2,000 $2,000/$4,000 Skull - depressed (except bones of face) $3,000/$6,000 $5,300/$10,600 Sternum $360/$720 $650/$1,300 Shoulder Blade $1,200/$2,400 $2,500/$5,000 Chip Fractures 25% of Non-Surgical Repair Fracture Amount ADDITIONAL BENEFIT(S) Sports Accident Benefit An additional 25% of the Accident Hospital Care, Accident Care, or Common Injuries benefit amount listed above, up to a maximum benefit of $1,000.

Accident Insurance Plan for Noblesville Schools Employees - Page 8 Accident Insurance Plan for Noblesville Schools Employees Page 7 Page 9