RL-ACC3-ADR2-23-IN 1 ADR-12967 (11/25) ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) RIDER RELIASTAR LIFE INSURANCE COMPANY 250 Marquette Avenue, Suite 900, Minneapolis, Minnesota 55401 POLICYHOLDER: Noblesville Schools GROUP POLICY NUMBER: 73058-1CAC2 This rider is made a part of the Group Accident Insurance Certificate and is subject to all of the provisions, limitations and exclusions of the Policy and Certificate, unless changed by this rider. Unless expressly changed by this rider, the terms used in this rider have the same meaning as in the Certificate. CONTENTS Section Page Schedule of Benefits................................................ 1 Definitions................................................................ 2 General Provisions................................................... 2 AD&D Benefits......................................................... 3 Exclusions................................................................ 4 Claims...................................................................... 4 SCHEDULE OF BENEFITS WHO PAYS FOR THE COVERAGE The cost of coverage under this rider is automatically included in the cost of your coverage and the cost of your Spouse's coverage and the cost of your Children's coverage. AD&D BENEFITS Accidental Death You: Low Plan $25,000 High Plan $100,000 Your Spouse $12,500 $50,000 Your Children: $5,000 $20,000 Common Carrier You: Low Plan $50,000 High Plan $200,000 Your Spouse $25,000 $100,000 Your Children: $12,500 $50,000