Accident Insurance Plan for Noblesville Schools Employees

YOUR ACCIDENT INSURANCE PLAN For Employees of Noblesville Schools D12967 (11/25) All Eligible Employees, excluding Bus Drivers, working 30 hours or more per week

RL-ACC3-CERT2-23-IN 1 D12967 (11/25) GROUP ACCIDENT INSURANCE CERTIFICATE OF COVERAGE RELIASTAR LIFE INSURANCE COMPANY 250 Marquette Avenue, Suite 900, Minneapolis, Minnesota 55401 Claims: 855-730-2902 Customer Service: 877-236-7564 POLICYHOLDER: Noblesville Schools GROUP POLICY NUMBER: 73058-1CAC2 POLICY EFFECTIVE DATE: January 1, 2026 GOVERNING JURISDICTION: Indiana THIS IS LIMITED BENEFIT INDEMNITY COVERAGE Benefits are paid for Covered Accidents as defined in the Certificate. The Policy does not constitute comprehensive health insurance coverage (often referred to as “major medical insurance coverage”). In addition, the Policy does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. Benefits are paid under the Policy for Covered Accidents as indemnity insurance and are not intended to cover medical expenses. ReliaStar Life Insurance Company certifies that we have issued the group Policy listed above to the Policyholder. The Policy is available for you to review if you contact the Policyholder for more information. This is your Certificate as long as you are eligible for coverage and you become insured. Please read it carefully and keep it in a safe place. This Certificate replaces any other Certificates we may have given you for the same level of coverage under the Policy. This Certificate summarizes and explains the parts of the Policy which apply to you. The Certificate is part of the group Policy but by itself is not a policy. Your coverage may be changed under the terms and conditions of the Policy. The Policy is delivered in and is governed by the laws of the governing jurisdiction and to the extent applicable by the Employee Retirement Income Security Act of 1974 (ERISA) and any amendments. For purposes of effective dates and ending dates under the Policy, all days begin at 12:01 a.m. standard time at the Policyholder's address and end at 12:00 midnight standard time at the Policyholder's address. The coverage under the Policy is conditionally renewable according to the terms and provisions of the Policy. In this Certificate, “you” and “your” refer to an Employee who is eligible for coverage under the Policy; “we”, “us” and “our” refer to ReliaStar Life Insurance Company. Exclusions may apply. Please read your Certificate carefully. Signed for ReliaStar Life Insurance Company at its home office in Minneapolis, Minnesota on the Policy effective date. Amelia (Amy) J. Vaillancourt President Melissa A. O'Donnell Secretary

Florida Residents - The benefits of the Policy providing Your coverage are governed primarily by the law of a state other than Florida. TABLE OF CONTENTS Section Page Cover Page................................................................................................................................................. 1 Table of Contents........................................................................................................................................ 2 Schedule of Benefits................................................................................................................................... 3 Definitions................................................................................................................................................... 8 General Provisions...................................................................................................................................... 11 Accident Benefits................................................................................................................................. 15 Exclusions................................................................................................................................................... 22 Claims......................................................................................................................................................... 22 RL-ACC3-CERT2-23-IN 2 D12967 (11/25)

RL-ACC3-CERT2-23-IN 3 D12967 (11/25) SCHEDULE OF BENEFITS EMPLOYER: Noblesville Schools GROUP POLICY NUMBER: 73058-1CAC2 ELIGIBLE CLASS(ES) All Eligible Employees, excluding Bus Drivers, working 30 hours or more per week in Active Employment with the Employer in the United States. You must be an Employee of the Employer and in an eligible class. Temporary and seasonal workers are excluded from coverage. Insured Persons who are continuing coverage under the PORTABILITY provision are also an eligible class. ELIGIBILITY WAITING PERIOD Persons in an eligible class on or before the Policy effective date: End of the month in which you begin Active Employment. Persons entering an eligible class after the Policy effective date: End of the month in which you begin Active Employment. Exception: if you were hired on the first of the month, the waiting period is waived. REHIRE If your employment with the Employer ends and you are rehired within 90 days, your previous Active Employment while in an eligible class will apply toward the Eligibility Waiting Period. All other Policy provisions apply. WHO PAYS FOR THE COVERAGE You pay the cost of your coverage.

RL-ACC3-CERT2-23-IN 4 D12967 (11/25) ACCIDENT BENEFITS ACCIDENT HOSPITAL CARE Low Plan High Plan Surgery - open abdominal, thoracic $1,000 $2,500 Surgery - exploratory or without repair $150 $400 Blood, Plasma, Platelets $400 $650 Hospital Admission $1,000 $2,000 Hospital Confinement $225 $400 Critical Care Unit (CCU) Admission $1,000 $2,000 Critical Care Unit (CCU) Confinement $350 $600 Rehabilitation Facility Confinement $150 $250 Non-Induced Coma $11,500 $20,000 Induced Coma $100 $250 Transportation $500 $850 Lodging $150 $225 Family Care $20 $40 ACCIDENT CARE Low Plan High Plan Initial Doctor Visit $60 $150 Urgent Care Facility Treatment $150 $300 Emergency Room Treatment $150 $350 Ambulance Ground $250 $600 Air $1,000 $2,500 Follow-Up Doctor Treatment $60 $150 Chiropractic Treatment $30 $75 Medical Equipment $400 $600 Physical or Occupational Therapy $50 $75 Speech Therapy $50 $75

RL-ACC3-CERT2-23-IN 5 D12967 (11/25) Prosthetic Device - one $500 $1,500 Prosthetic Device - 2 or more $800 $2,400 Prescription Medicine $10 $20 Major Diagnostic Exams CT (computerized tomography) or CAT scan (computerized axial tomography) $125 $500 MRI (magnetic resonance imaging) $125 $500 EEG (electroencephalogram) $125 $500 PET (positron emission tomography) scan $125 $500 Ultrasound $125 $500 Outpatient Surgery $150 $300 X-ray $50 $100 COMMON INJURIES Low Plan High Plan Burns 2nd degree - at least 36% of the total body surface area $1,000 $1,750 3rd degree - at least 2% but less than 4% of the total body surface area $4,500 $10,000 3rd degree - 4% or more of the total body surface area $10,000 $22,000 Skin Grafts 50% of Burn Benefit 50% of Burn Benefit Emergency Dental Work Crown $250 $480 Extraction $60 $180 Eye Injury Surgery $225 $420 Removal of foreign object $150 $300 Torn Hip, Knee or Shoulder Cartilage Surgery with no repair or if cartilage is shaved $150 $280 Surgical repair $500 $1,000 Laceration (total of all lacerations) treated, no sutures $20 $60 sutures, up to 2 inches $50 $120 sutures, 2 to 6 inches $160 $480 sutures, over 6 inches $400 $960 Puncture Wound $25 $75 Ruptured Disk - surgical repair $500 $1,000

RL-ACC3-CERT2-23-IN 6 D12967 (11/25) Tendon/Ligament/Rotator Cuff One, surgical repair $550 $1,020 2 or more, surgical repair $800 $1,520 Exploratory Arthroscopic Surgery with no repair $275 $720 Concussion $150 $450 Traumatic Brain Injury $1,250 $2,500 Paralysis Quadriplegia $16,000 $30,000 Paraplegia $12,000 $20,000 Hemiplegia $10,000 $20,000 Monoplegia $5,000 $15,500 Low Plan High Plan Dislocations (Complete & Complete Requiring Surgical Repair) Complete / Complete Requiring Surgical Repair Complete / Complete Requiring Surgical Repair Hip Joint $2,550/$5,100 $5,000/$10,000 Knee $1,600/$3,200 $3,000/$6,000 Ankle or Foot Bone(s) other than toes $1,000/$2,000 $1,800/$3,600 Shoulder $1,000/$2,000 $2,200/$4,400 Elbow $750/$1,500 $1,500/$3,000 Wrist $750/$1,500 $1,500/$3,000 Finger/Toe $175/$350 $350/$700 Hand Bone(s) other than fingers $750/$1,500 $1,500/$3,000 Lower Jaw $750/$1,500 $1,500/$3,000 Collarbone $750/$1,500 $1,500/$3,000 Incomplete Dislocations 25% of Complete Dislocation Amount Fractures (Non-Surgical Repair Fracture & Fracture Requiring Surgical Repair) Non-Surgical Repair Fracture / Fracture Requiring Surgical Repair Non-Surgical Repair Fracture / Fracture Requiring Surgical Repair Hip $2,000/$4,000 $6,000/$12,000 Leg $1,500/$3,000 $3,000/$6,000 Ankle $1,200/$2,400 $2,500/$5,000 Kneecap $1,200/$2,400 $2,500/$5,000 Foot (excluding toes, heel) $1,200/$2,400 $2,500/$5,000 Heel $1,200/$2,400 $2,500/$5,000 Upper Arm $1,400/$2,800 $2,750/$5,500 Forearm, Hand, Wrist (except fingers) $1,200/$2,400 $2,500/$5,000 Finger, Toe $160/$320 $400/$800 Vertebral Body $2,240/$4,480 $4,200/$8,400 Vertebral Processes $960/$1,920 $2,000/$4,000 Pelvis (except Coccyx) $2,250/$4,500 $4,000/$8,000 Coccyx $300/$600 $750/$1,500 Bones of Face (except nose) $800/$1,600 $1,400/$2,800 Nose $400/$800 $750/$1,500 Upper Jaw $1,000/$2,000 $1,750/$3,500 Lower Jaw $960/$1,920 $2,000/$4,000 Collarbone $960/$1,920 $2,000/$4,000 Rib $300/$600 $600/$1,200

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.

RL-ACC3-CERT2-23-IN 8 D12967 (11/25) DEFINITIONS Accident or Accidental means an unforeseen event that results in a bodily Injury. Active Employment or Active Employee means you are working for the Employer for earnings that are paid regularly and you are performing the material and substantial duties of your regular occupation. Your work site must be one of the following:  The Employer's usual place of business;  An alternative work site at the direction of the Employer, including your home; or  A location to which your job requires you to travel. Normal vacation is considered Active Employment. Certificate means this document, which describes the benefits and rights of Insured Persons under the Policy. It may include riders, endorsements or amendments. Chip Fracture means a Fracture in which a piece of the bone is broken off near a joint at a place where a ligament is usually attached. Chiropractor means a person other than you or any family member, who is licensed to diagnose and treat neuromuscular disorders, with an emphasis on treatment through manual adjustment and/or manipulation of the spine, in the state in which treatment is received and providing treatment or advice in accordance with the license. Confined or Confinement means that on the advice of a Doctor, your assignment to a bed as a resident inpatient in a Hospital or Critical Care Unit or Rehabilitation Facility. Being admitted to an Observation Unit for 20 hours or more also meets the definition of Confined or Confinement. There must be a charge for room and board for the confinement, other than in any government, military or veterans’ facility or Observation Unit. Covered Accident means an Accident that:  occurs on or after your coverage effective date and the effective date of any riders,  occurs while your coverage is in force, and  is not excluded by name or specific description in the Policy. Critical Care Unit means a specifically designated part of a Hospital commonly referred to as an intensive care unit which meets all of the following requirements:  It provides the highest level of medical care and is restricted to patients who are critically ill or injured and who require intensive comprehensive observation and care.  It is separate and apart from the surgical recovery room and from rooms, beds and wards customarily used for patient confinement.  It is permanently equipped with special lifesaving equipment for the care of the critically ill or injured.  It is under constant and continuous observation by a specially trained nursing staff assigned exclusively to the intensive care unit on a 24 hour basis.  It is assigned a Doctor on a full-time basis. Critical Care Unit does not include a sub-acute intensive care unit that provides a level of medical care below intensive care, but above a regular private or semi-private room or ward such as a step-down unit. Dislocation means a separated joint.  Complete Requiring Surgical Repair means a completely separated joint that requires surgical repair.  Complete means a completely separated joint that does not require surgical repair.  Incomplete means the joint is not completely separated.

RL-ACC3-CERT2-23-IN 9 D12967 (11/25) Eligibility Waiting Period means the continuous period of time as shown in the SCHEDULE OF BENEFITS that you must be in Active Employment in an eligible class before you are eligible for coverage under the Policy. Emergency Room means a specified area within a Hospital, or a standalone facility licensed as an emergency room with the state, that is designated for emergency care. Employee means a person who is a citizen or legal resident of the United States in Active Employment with the Employer in the United States. The term includes a person whose coverage is being continued under the PORTABILITY provision, even if the person is no longer in Active Employment with the Employer. Employer means the Policyholder and includes any division, subsidiary or affiliated company named in the Policy. Fracture means a broken bone that can be seen by x-ray.  Fracture Requiring Surgical Repair means the fracture is repaired through a surgical incision.  Non-Surgical Repair means the fracture is reduced or repaired without a surgical incision. Hospital means an institution that is run for the care and treatment of sick or injured persons as inpatients and which, on its premises or in facilities available to the Hospital on a pre-arranged basis, fully meets each of the following requirements:  It is operated in accordance with the laws pertaining to hospitals in the jurisdiction in which it is located.  It is under the supervision of a medical staff and has one or more Doctors available at all times.  It provides 24 hours a day service by registered graduate nurses (RNs).  It is not an institution or any part of an institution used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a free-standing surgical center; a rehabilitative facility; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction. Insured Person means an Employee who is eligible for coverage under the Policy, becomes covered according to the terms of the Policy, and whose coverage remains in effect according to the terms of the Policy. Observation Unit means a specified area within a Hospital, apart from the Emergency Room, where a patient can be monitored by a Doctor, and that fully meets each of the following requirements:  It is under the direct supervision of a Doctor or registered nurse.  It is staffed by nurses assigned specifically to that unit.  It provides care seven days per week, 24 hours per day. Outpatient Surgery means surgical services received at a Hospital or free-standing facility such as a surgical center licensed by the state to render outpatient surgery. The surgical service must be performed by a board certified surgical specialist with anesthesia rendered by a separate provider. Policy means the Written group insurance contract between the Policyholder and us, including the Certificates delivered to Insured Persons. It may include riders and endorsements. Policyholder means the Employer to whom the Policy is issued, as shown on the first page of this Certificate, and who sponsors the coverage for its Employees. Doctor means a person other than you or any family member, who is licensed to practice medicine in the state in which treatment is received and providing treatment or advice in accordance with the license. State law may require consideration of professional services of a practitioner other than a medical doctor. If so, then this definition includes persons recognized as qualified to treat the condition for which claim is made by the state in which treatment is received. Injury means a bodily Injury that is the direct result of a Covered Accident and not related to any other cause. Injuries must be independent of Sickness, disease, bodily infirmity and other causes.

RL-ACC3-CERT2-23-IN 10 D12967 (11/25) Rehabilitation Facility means a free-standing facility providing coordinated multidisciplinary physical restorative services to inpatients under the direction of a Doctor knowledgeable and experienced in rehabilitative medicine. A Rehabilitation Facility must meet all the following requirements:  It is licensed and operated pursuant to law.  It provides treatment and care for ill and injured persons on an inpatient basis.  It provides 24 hours a day service by registered graduate nurses (RNs).  It is not an institution or any part used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction. Rehabilitation Facility includes a unit of a Hospital with beds set up and staffed and specifically designated for rehabilitative medicine. Signed means any symbol or method executed or adopted by a person with the present intention to authenticate a record, which is on or transmitted by paper or electronic or telephonic media, and which is consistent with applicable law. Telehealth means a medical encounter with a Doctor or licensed medical professional via telecommunication and information technologies (including, but not limited to, audio or video communications) for evaluation, diagnosis, or treatment as would be practiced in person. This does not include requests for prescription refills or medical records. Urgent Care Facility means a specified area within a Hospital, or a standalone facility, licensed as an urgent care center with the state, that provides outpatient immediate and semi-urgent healthcare of non-life threatening injuries or illnesses. Urgent Care Facility does not include an Emergency Room as defined. Written or Writing means a record which is on or transmitted by paper or electronic or telephonic media, and which is consistent with applicable law. Sickness means illness, infection, disease or any other abnormal physical condition that is not due to an Injury. Sickness includes pregnancy, infection and any other abnormal physical condition that is not caused by an Accident.

RL-ACC3-CERT2-23-IN 11 D12967 (11/25) EFFECTIVE DATE OF COVERAGE You will be covered at 12:01 a.m. standard time at the Policyholder’s address on the latest of the following:  The date you are eligible for coverage, if you enroll for coverage on or before that date.  The first day of the month that is on or next follows the date you enroll for coverage.  The first day of the month that is on or next follows the date you return to Active Employment, if you are not in Active Employment when your coverage would otherwise become effective. Exception: Coverage starts on a non- working day if you were in Active Employment on your last scheduled working day before the non-working day. Non-working days include time off for the following: vacations, personal holidays, weekends and holidays, approved non-medical leave of absence and paid time off for non-medical-related absences. .. EFFECTIVE DATE OF CHANGES TO COVERAGE Once your coverage begins, any increased or additional coverage will take effect on the latest of the following:  The date of the increased or additional coverage, if you are in Active Employment.  The date you return to Active Employment, if you are not in Active Employment due to injury or sickness. Any decrease in coverage will take effect immediately but will not affect a payable claim that occurs prior to the decrease. CHANGE OF INSURANCE CARRIERS If you are not in Active Employment due to Injury or Sickness or Employer-approved non-medical leave of absence on the effective date of the Employer’s coverage under our Policy, and you were covered under the Employer’s prior group policy of accident insurance at the time the Employer's coverage under our Policy became effective, we will provide continuity of coverage under our Policy. In order for this provision to apply, the prior policy's coverage must be similar to our Policy. If you are not in Active Employment due to Injury or Sickness or Employer-approved nonmedical leave of absence on the effective date of our Policy, and you would otherwise be eligible to become insured under our Policy, we will provide limited coverage under our Policy. Coverage under this provision will begin on our Policy effective date and will continue until the earliest of the following:  The date you return to Active Employment.  The end of any period of continuance or extension provided under the prior policy.  The date coverage would otherwise end, according to the provisions of our Policy. Your coverage under this provision is subject to payment of premiums. Any benefits payable under this provision will be paid as if the prior policy had remained in force. We will reduce our payment by any amount for which the prior carrier is liable. If your coverage ends under this provision, or if you were not covered under the Employer's prior policy on the date that policy terminated, the EFFECTIVE DATE OF COVERAGE provision under our Policy will apply. GENERAL PROVISIONS ELIGIBILITY If you are an Employee in an eligible class as shown on the SCHEDULE OF BENEFITS, the date you are eligible for coverage is the later of the following:  The Policy effective date.  The date you enter an eligible class.  The day after you complete your Eligibility Waiting Period. ENROLLMENT If you are eligible for coverage, you must enroll for any coverage before it will become effective. The Employer or we will provide you with the forms or information needed to complete your enrollment. You may enroll when you become newly eligible, or following a qualifying life event as allowed by the Employer, or during an enrollment period chosen by the Employer and approved by us.

RL-ACC3-CERT2-23-IN 12 D12967 (11/25) TERMINATION OF COVERAGE Your coverage under the Policy ends on the earliest of the following dates:  The date the Policy terminates. See the PORTABILITY provision.  The date you are no longer in an eligible class. See the PORTABILITY provision.  The date your eligible class is no longer covered. See the PORTABILITY provision.  The date you voluntarily cancel your coverage.  The end of the period for which premiums are paid, if the next premium is not paid by its due date, subject to the GRACE PERIOD provision.  The last day you are in Active Employment. See the PORTABILITY provision. We will pay benefits for a loss that occurs while you are covered under the Policy even if the Policy has since terminated. POLICY TERMINATION The Policy can be terminated either by us or by the Policyholder. We may terminate the Policy for any of the following reasons:  There is less than 15% participation of those eligible persons who pay all or part of their premium for the Policy.  The Policyholder does not promptly provide us with information that is reasonably required.  Fewer than 25 persons are insured under the Policy.  The premium is not paid in accordance with the provisions of the Policy.  We determine that there is a significant change in the size, occupation or age of the eligible class(es) as a result of a corporate transaction such as a merger, divestiture, acquisition, sale or reorganization of the Policyholder and/or its persons.  We stop providing accident coverage to all groups in the Policy issue state. We reserve the right to review and terminate all class(es) covered under the Policy if any class(es) cease(s) to be covered. If the Policyholder fails to pay the full premium due by the end of the grace period, the Policy will terminate according to the GRACE PERIOD provision. If we terminate the Policy for reasons other than the Policyholder's failure to pay premiums, Written notice will be mailed to the Policyholder at least 60 days prior to the termination date. The Policyholder may terminate the Policy by Written notice delivered to us at our home office prior to the termination date. When both the Policyholder and we agree, the Policy can be terminated on an earlier date. If the Policyholder or we terminate the Policy, coverage will end at 12:00 midnight standard time at the Policyholder's address on the termination date. If the Policy is terminated, the termination will not affect a payable claim. PORTABILITY Portability means you have the option to continue your coverage after it would otherwise terminate, if certain conditions are met. You must elect portability before you reach age 75. You may continue your coverage if it would otherwise terminate due to any of the following:  You retire or terminate employment with the Employer, if coverage remains in effect under the Policy for other Active Employees.  Coverage terminates under the Policy for all Insured Persons except those individuals on portability, and the Policyholder does not replace it with similar insurance coverage.  You are no longer eligible for coverage under the Policy.

RL-ACC3-CERT2-23-IN 13 D12967 (11/25) The Employer or we will provide you with the information needed to continue your coverage under this provision. Continuation of coverage must be elected within 31 days of when it would otherwise terminate. Coverage continued under this provision is subject to all the terms of this Certificate. You may decrease the continued coverage amount based on the amounts available on the SCHEDULE OF BENEFITS. You may not increase the continued coverage amount. Continued premium payment is required to keep coverage in force. Premiums will be billed directly to you. The initial premium will be based on the portability premium rates in effect at the time you are eligible to continue your coverage under this provision. We may change the portability premium rates at any time upon 60 days Written notice to you. Coverage continued under this provision will end on the earliest of the following:  The end of the period for which premiums are paid if the next premium is not paid by its due date, subject to the GRACE PERIOD provision.  The date you die.  The date the Policy terminates because we stop providing accident coverage to all groups in the Policy issue state and coverage terminates for all Insured Persons and any other persons covered under any riders under the Policy. We will provide 60 days Written notice of termination. GRACE PERIOD The Policyholder has a grace period of 60 days for the payment of any premium due except the first premium payment. During the Policyholder’s grace period the Policy will remain in force. If the full premium payment is not received by us by the end of the grace period, the Policy will automatically terminate at the end of the grace period. The Policyholder is required to pay a pro rata premium for any period the Policy was in force during the grace period. There is no grace period if the Policyholder gives us advance Written notice of termination, or if we have given the Policyholder advance Written notice of termination as described under the POLICY TERMINATION provision. If you are continuing your coverage under the PORTABILITY provision, you have a grace period of 31 days for the payment of any premium due. During your grace period, your coverage will remain in force. If the full premium payment is not received by us by the due date, we will give Written notification to you that if the premium is not paid by the end of the grace period, all coverage will terminate on the last day of the grace period. If we fail to give such Written notice, coverage will continue in effect until the date such notice is given. We may extend the grace period by giving Written notice of such intent to you, and such notice will specify that all coverage will terminate on that date if the premium remains unpaid. A pro rata premium payment is required for any period your coverage was in force during the grace period. CLERICAL ERROR Clerical error or omission by the Policyholder or us will not:  Prevent you from being covered, if you are entitled to coverage under the terms of the Policy.  Cause coverage to begin or continue for you when the coverage would not otherwise be effective.  End insurance validly in effect. If the Policyholder gives us information about you that is incorrect, we will do both of the following:  Use the facts to decide whether you are eligible for coverage under the Policy and in what amounts.  Make a fair adjustment of the premium. REPRESENTATIONS NOT WARRANTIES All statements made by the Policyholder and you are considered representations and not warranties. INCONTESTABILITY We will not use any statements made by you to avoid insurance, reduce benefits or defend a claim unless the statement is included in a Written application or enrollment form relating to your insurability. Except for fraud, we will not use such statements to contest insurance after it has been in force for two years from its effective date. Fraud in the procurement of coverage under the Policy is only contestable after the coverage has been in force for two years from its effective date if permitted by applicable law in the governing jurisdiction. The statement on which any contest is based must be material to the risk accepted or the hazard assumed by us.

RL-ACC3-CERT2-23-IN 14 D12967 (11/25) ASSIGNMENT No assignment of benefits under the Policy is valid, unless otherwise specified in the Policy. AGENCY For purposes of the Policy, the Policyholder acts on its own behalf or as your agent. Under no circumstances will the Policyholder be deemed our agent. CONSUMER NOTICE Questions regarding your policy or coverage should be directed to: ReliaStar Life Insurance Company 877-236-7564 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. CONFORMITY WITH STATE STATUTES Any provision of the Policy which, on the Policy effective date and each subsequent Policy anniversary date, conflicts with any law that applies in the governing jurisdiction, is automatically amended to conform to the minimum requirements of such law. CHANGES TO POLICY OR CERTIFICATE The Policy may be amended at any time by Written agreement between the Policyholder and us. No change in the Policy will be valid until approved by one of our executive officers. Such approval must be in Writing and will be endorsed or attached to the Policy. Changes requiring regulatory approval will not be valid until approved by the appropriate regulatory body. We will issue new Certificates or riders or endorsements to effect such changes, and only those forms Signed by one of our executive officers will be valid. No agent, representative or employee of ours or of any other entity, except one of our executive officers, may approve a change to waive any terms of the Policy.

RL-ACC3-CERT2-23-IN 15 D12967 (11/25) ACCIDENT BENEFITS ACCIDENT HOSPITAL CARE BENEFITS We will pay an ACCIDENT HOSPITAL CARE benefit as shown on the SCHEDULE OF BENEFITS if you receive any of the services or meet any of the conditions described below as the result of Injuries received in a Covered Accident. The Injury must occur while you are covered under the Policy. Blood, Plasma, Platelets: Transfusion, administration, cross matching, typing and processing of blood, plasma, platelets administered within 90 days after a Covered Accident. This benefit is payable once per Covered Accident. Critical Care Unit Admission: Admission to a Critical Care Unit as a result of a Covered Accident. The admission must begin within 6 months after a Covered Accident. This benefit is payable once per Covered Accident. No benefit is payable for any of the following:  Emergency Room treatment.  Outpatient Surgery. If you qualify for any of the following benefits on the same day, only one benefit in the higher amount will be payable:  Hospital Admission  Hospital Confinement  Critical Care Unit (CCU) Admission  Critical Care Unit (CCU) Confinement  Rehabilitation Facility Confinement Critical Care Unit Confinement: Confinement in a Critical Care Unit for at least 20 consecutive hours on an inpatient basis as the result of a Covered Accident. The Confinement must begin within 30 days after a Covered Accident. Benefits are payable daily for up to 30 days for a Covered Accident. Benefits are payable for only one Critical Care Unit Confinement at a time even if the Confinement is caused by more than one Covered Accident. Only one type of Confinement benefit is payable for each period of eligible Confinement. If you qualify for any of the following benefits on the same day, only one benefit in the higher amount will be payable:  Hospital Admission  Hospital Confinement  Critical Care Unit (CCU) Admission  Critical Care Unit (CCU) Confinement  Rehabilitation Facility Confinement If you are discharged from the Critical Care Unit and then re-Confined within 30 days due to the same Covered Accident or due to a related condition, the re-Confinement will be considered part of the previous Critical Care Unit Confinement(s). Family Care: You have an eligible family member attending a family care center or receiving family care while you are Confined in a Hospital or Critical Care Unit or a Rehabilitation Facility as the result of a Covered Accident. Benefits are payable daily during and immediately following your Confinement for up to a total of 45 days. This benefit is payable once per day regardless of the number of eligible family members receiving care. Written proof of the expense incurred must be furnished along with any proof of claim. “Eligible family member” for this benefit means a relative who is dependent on you for support and maintenance due to physical or intellectual disability and resides with you at the time of your Covered Accident. “Eligible family member” for this benefit also includes your dependent child under age 13. Written proof of an eligible family member must be furnished along with any proof of claim. “Family care center” for this benefit means any child or adult care facility or private care that:  Is licensed as such by the state.  Provides non-medical care and supervision for children or adults.  Is not operated by you or a member of your immediate family.

RL-ACC3-CERT2-23-IN 16 D12967 (11/25) “Family care” for this benefit means care provided in a family care center as defined or provided in your home where:  Non-medical care and supervision for children or adults is provided.  The care and supervision is not provided by you or a member of your immediate family. Hospital Admission: Admission to a Hospital as a result of a Covered Accident. The admission must begin within 6 months after a Covered Accident. This benefit is payable once per Covered Accident. No benefit is payable for any of the following:  Emergency Room treatment.  Outpatient Surgery. If you qualify for any of the following benefits on the same day, only one benefit in the higher amount will be payable:  Hospital Admission  Hospital Confinement  Critical Care Unit (CCU) Admission  Critical Care Unit (CCU) Confinement  Rehabilitation Facility Confinement Hospital Confinement: Confinement in a Hospital for at least 20 consecutive hours on an inpatient basis as the result of a Covered Accident. The Hospital Confinement must begin within 6 months after a Covered Accident. Benefits are payable daily for up to 365 days for a Covered Accident. Benefits are payable for only one Hospital Confinement at a time even if the Confinement is caused by more than one Covered Accident. Only one type of Confinement benefit is payable for each period of eligible Confinement. If you qualify for any of the following benefits on the same day, only one benefit in the higher amount will be payable:  Hospital Admission  Hospital Confinement  Critical Care Unit (CCU) Admission  Critical Care Unit (CCU) Confinement  Rehabilitation Facility Confinement If you are discharged from the Hospital and then re-Confined within 30 days due to the same Covered Accident or due to a related condition, the re-Confinement will be considered part of the previous Hospital Confinement(s). Induced Coma: An induced coma as the result of a Covered Accident. An induced coma is a temporary state of unconsciousness brought on by a controlled dose of medicine administer by a Doctor at a Hospital. Induced coma does not include general anesthesia administered for purposes of surgery. This benefit is payable for each day you are in an induced coma up to a maximum of 14 days. Lodging: Hotel/motel stay by your companion while you are Confined in a Hospital or Critical Care Unit or a Rehabilitation Facility. The Hospital must be more than 100 miles from your home. The companion must be 16 years of age or older. This benefit is payable for up to 30 days per Covered Accident. Non-induced Coma: You have been in a non-induced coma, as the result of a Covered Accident for at least 14 days. A non-induced coma is a state of unconsciousness that is not medically induced with:  no reaction to external stimuli,  no reaction to internal needs, and  the use of life support systems. This benefit is payable once per Covered Accident. Rehabilitation Facility Confinement: Confinement in a Rehabilitation Facility for 20 consecutive hours on an inpatient basis as the result of a Covered Accident. Benefits are payable daily for each subsequent and continuous day (or portion thereof) of inpatient Rehabilitation Facility Confinement, for up to 90 days per Covered Accident. Benefits are payable for only one Rehabilitation Facility Confinement at a time even if the Confinement is caused by more than one Covered Accident. Only one type of Confinement benefit is payable for each period of eligible Confinement. If you qualify for any of the following benefits on the same day, only one benefit in the higher amount will be payable:

RL-ACC3-CERT2-23-IN 17 D12967 (11/25)  Hospital Admission  Hospital Confinement  Critical Care Unit (CCU) Admission  Critical Care Unit (CCU) Confinement  Rehabilitation Facility Confinement If you are released and readmitted to a Rehabilitation Facility within 30 days due to the same Covered Accident or due to a related condition, the re-Confinement will be considered part of the previous Rehabilitation Facility Confinement(s). Surgery: The surgery must take place within 30 days after a Covered Accident. The benefit amount varies based on the type of services received as shown on the SCHEDULE OF BENEFITS. This benefit is payable once per Covered Accident. If your surgery meets more than one of the surgery classifications, the higher amount will be payable. No benefit is payable for hernia repair. Transportation: Transportation for you for special treatment and Confinement in a Hospital or Critical Care Unit or a Rehabilitation Facility. The special treatment must be prescribed by a Doctor and not available locally. The transportation must be more than 100 miles one way. This benefit is payable up to 3 trips per Covered Accident. No benefit is payable for transportation by ground ambulance or air ambulance. ACCIDENT CARE BENEFITS We will pay an ACCIDENT CARE benefit as shown on the SCHEDULE OF BENEFITS if you receive any of the services or meet any of the conditions described below as the result of Injuries received in a Covered Accident. The Injury must occur while you are covered under the Policy. Ambulance, Air: Transport by a licensed professional air ambulance company to or from a Hospital or between medical facilities, for treatment of Injuries received as the result of a Covered Accident. The transport must be within 48 hours after the Covered Accident. This benefit is payable once per Covered Accident. Ambulance, Ground: Transport by a licensed professional ambulance company to or from a Hospital or between medical facilities, for treatment of Injuries received as the result of a Covered Accident. The transport must be within 90 days after the Covered Accident. This benefit is payable once per Covered Accident. Chiropractic Treatment: Treatment must be received by a Chiropractor in a Chiropractor's office. The treatment must begin within 90 days after a Covered Accident and be completed within 12 months after the Covered Accident. This benefit is payable up to 6 times per Covered Accident. Emergency Room Treatment: Examination and treatment by a Doctor in an Emergency Room within 30 days after a Covered Accident. This benefit is payable once per Covered Accident. Follow-Up Doctor Treatment: Follow-up treatment by a Doctor must begin within 60 days after a Covered Accident and be completed within 12 months after the Covered Accident. This benefit is only available if you are eligible for the Initial Doctor Visit benefit or the Emergency Room treatment benefit or the Urgent Care Facility treatment benefit. Follow-up treatment may be provided by a Doctor via Telehealth. This benefit is payable up to 6 times per Covered Accident. Initial Doctor Visit: Examination and treatment by a Doctor within 30 days after a Covered Accident. Examination and treatment does not include care by Chiropractor. Examination and treatment may be provided by a Doctor via Telehealth. This benefit is payable once per Covered Accident. Major Diagnostic Exams: A major diagnostic exam must be prescribed by a Doctor and must occur within 6 months after the Covered Accident. This benefit is payable once per Covered Accident.

RL-ACC3-CERT2-23-IN 18 D12967 (11/25) Medical Equipment: The medical equipment must be prescribed by a Doctor and use must begin within 6 months after the Covered Accident. This benefit is payable once per Covered Accident. The types of eligible equipment are:  Crutches.  Wheelchair.  Back Brace.  Leg Brace.  Walker. Outpatient Surgery: Miscellaneous surgery that is not covered by any other Injury benefit. The surgery must take place within 12 months after a Covered Accident. No benefit is payable for hernia repair. This benefit is payable up to 2 times per Covered Accident. Physical or Occupational Therapy: Therapy must be prescribed by a Doctor and provided by a physical therapist or by an occupational therapist in an office or Hospital or a Rehabilitation Facility on an inpatient or outpatient basis. Therapy may also be provided by a physical therapist or occupational therapist via Telehealth. The therapy must begin within 180 days after a Covered Accident and be completed within 12 months after the Covered Accident. This benefit is payable up to 10 times per Covered Accident. “Physical therapist” for this benefit means a person other than you or any family member, who is a licensed health care professional in the state in which treatment is received and providing treatment or advice in accordance with the license. A physical therapist provides services and practices according to the Code of Ethics of the American Physical Therapy Association. “Occupational therapist” for this benefit means a person other than you or any family member, who is a licensed health care professional in the state in which treatment is received and providing treatment or advice in accordance with the license. An occupational therapist provides services designed to restore self-care, work, and leisure skills to patients/clients who have specific performance incapacities or deficits that reduce their abilities to cope with the tasks of everyday living. An occupational therapist evaluates and treats problems arising from developmental deficits, physical illness or injury, emotional disorders, the aging process, and psychological or social disability. Prescription Medicine: Medicine prescribed by a Doctor due to Injuries received in a Covered Accident and filled at a pharmacy within 90 days of the Covered Accident. This benefit is payable once per Covered Accident. No benefit is payable for:  Medication administered while Confined or during surgery.  Medication administered on an outpatient basis.  Medication that is recommended by a Doctor that is over-the counter or available without a prescription.  Devices or medical equipment.  Refills of prescription medicine for which we previously paid benefits. Prosthetic Device: You receive a prosthetic device prescribed by a Doctor for use following the loss of use of a hand, a foot or the sight of an eye. The prosthetic device must be received within one year of a Covered Accident. The benefit amount varies based on the number of prosthetic devices received as shown on the SCHEDULE OF BENEFITS. This benefit is payable once per Covered Accident. Prosthetic devices do not include any of the following:  Hearing aids.  Dental aids including false teeth.  Eye-glasses.  Artificial joints.  Cosmetic prostheses such as hair wigs. Speech Therapy: Therapy for the treatment of speech and communication disorders. The approach used varies depending on the disorder. It may include physical exercises to strengthen the muscles used in speech (oral-motor work), speech drills to improve clarity, or sound production practice to improve articulation. Speech therapy must be prescribed by a Doctor and provided by a speech therapist in an office or Hospital or a Rehabilitation Facility on an inpatient or outpatient basis. Therapy may also be provided by a speech therapist via Telehealth. The therapy must begin within 180 days after a Covered Accident and be completed within 12 months after the Covered Accident. This benefit is payable up to 10 times per Covered Accident.

RL-ACC3-CERT2-23-IN 19 D12967 (11/25) “Speech therapist” for this benefit means a person other than you or any family member, who is a licensed health care professional in the state in which treatment is received and providing treatment or advice in accordance with the license. A speech therapist is trained to evaluate and treat voice, speech, language, or swallowing disorders–e.g., hearing impairment, that affect speech (oral-motor-work) and communication. Urgent Care Facility Treatment: Examination and treatment by a Doctor in an Urgent Care Facility within 30 days after a Covered Accident. This benefit is payable once per Covered Accident. X-ray: An x-ray must be prescribed by a Doctor. This benefit is payable within 90 days of a Covered Accident and is payable once per Covered Accident. COMMON INJURIES BENEFITS We will pay a COMMON INJURIES benefit as shown on the SCHEDULE OF BENEFITS if you receive any of the services or meet any of the conditions described below as the result of Injuries received in a Covered Accident. The Injury must occur while you are covered under the Policy. Burns: The burn must be treated by a Doctor within 3 days after a Covered Accident. The benefit amount varies based on the burn classification as shown on the SCHEDULE OF BENEFITS. If your burn meets more than one of the burn classifications, the higher amount will be payable. This benefit is payable once per Covered Accident. Concussion: The concussion must be diagnosed by a Doctor within 3 days after a Covered Accident. The diagnosis must be confirmed by the use of some type of medical imaging procedure; i.e. x-ray, CT scan or MRI. Dislocations: The Dislocation must be diagnosed by a Doctor within 90 days after a Covered Accident. The benefit amount will vary based on whether the Dislocation is Complete, Complete Requiring Surgical Repair or Incomplete as shown on the SCHEDULE OF BENEFITS. Dislocations that are Complete or Complete Requiring Surgical Repair must be repaired by a Doctor. If you receive more than one Dislocation in the same Covered Accident, a benefit is payable for all Dislocations. However, the benefit will be no more than two times the benefit amount for the joint involved which pays the highest benefit amount. If you receive a Dislocation and a Fracture in the same Covered Accident, a benefit is payable for both. However, the benefit will be no more than two times the amount for the bone or joint involved which pays the highest benefit amount. This benefit is payable 2 times per joint per lifetime of the Policy. Subsequent Dislocations of the same joint after this maximum in a different Covered Accident are not covered. Emergency Dental Work: Natural teeth must be damaged due to a Covered Accident and either extracted or repaired by the placement of a crown. The benefit amount varies based on the type of services received as shown on the SCHEDULE OF BENEFITS. This benefit is payable once per Covered Accident regardless of the number of teeth involved. Eye Injury: The eye Injury must be treated by a Doctor within 90 days after a Covered Accident. The Injury must require surgery or the removal of a foreign object by a Doctor. The benefit amount varies based on the type of services received as shown on the SCHEDULE OF BENEFITS. This benefit is payable once per Covered Accident. No benefit is payable for examination with anesthesia or for an Injury to the eyelid which is the moveable fold of skin and muscle that covers the eye. Fractures: The Fracture must be diagnosed by a Doctor within 90 days after a Covered Accident. The Fracture must require treatment by a Doctor. If the Doctor diagnoses the Fracture as a Chip Fracture, the benefit will be reduced to a percentage of what would have been paid for a Non-Surgical Repair Fracture of the same bone. The benefit amount varies based on the type of services received as shown on the SCHEDULE OF BENEFITS. If you receive more than one Fracture in a Covered Accident, a benefit is payable for all Fractures. However, the benefit will be no more than two times the benefit amount listed for the bone which pays the highest benefit amount.

RL-ACC3-CERT2-23-IN 20 D12967 (11/25) If you receive a Fracture and a Dislocation in the same Covered Accident, a benefit is payable for both. However, the benefit will be no more than two times the amount for the bone or joint involved which pays the highest benefit amount. Laceration: A laceration is a cut. The laceration must be treated by a Doctor within 3 days after a Covered Accident. The benefit amount will be based on the total length of all lacerations requiring repair that are received in any one Covered Accident as shown on the SCHEDULE OF BENEFITS. If the laceration is severe enough to require sutures but the Doctor chooses to repair it another way, the benefit will be determined as if the laceration was sutured. This benefit is payable once per Covered Accident. If your Injury qualifies as both a laceration and puncture wound, only one benefit in the higher amount will be payable. Paralysis: Spinal cord Injuries sustained in a Covered Accident that result in the loss of use of one or more arms and legs.  Hemiplegia = the complete and irreversible paralysis of both limbs on either side of the body  Monoplegia= the complete and irreversible paralysis of one limb  Paraplegia = the complete and irreversible paralysis of both legs.  Quadriplegia = the complete and irreversible paralysis of both arms and both legs. Paralysis must be confirmed by a Doctor and based on documented evidence of the Injury that caused the paralysis. The duration of the paralysis must be at least 30 days and expected to be permanent. The benefit amount varies based on the degree of paralysis as shown on the SCHEDULE OF BENEFITS. This benefit is payable once per Covered Accident. Puncture Wound: An Injury caused by an object, including a needle, that pierces or penetrates the skin. The puncture wound must be treated by a Doctor within 72 hours after a Covered Accident. This benefit is payable once per Covered Accident. If your Injury qualifies as both a laceration and puncture wound, only one benefit in the higher amount will be payable. Ruptured Disk: You must receive surgical repair of a ruptured disk by a Doctor. The surgical repair must occur within 2 years after the Covered Accident. This benefit is payable once per Covered Accident. Skin Graft: The skin graft is for a burn for which a benefit was paid under the burn benefit in this section. This benefit is payable once per Covered Accident. Traumatic Brain Injury: A brain Injury that is caused by a traumatic sudden impact to the head, neck or shoulders, or a penetration of the head. The traumatic brain Injury must be initially treated by a Doctor within 90 days after a Covered Accident. The diagnosis by a Doctor must occur within 90 days after the Covered Accident. The diagnosis must include a Glasgow Coma Scale score of 8 or less (or equivalent) and the inability to perform independently 2 or more of the following activities of daily living:  Eating;  Bathing;  Dressing;  Toileting;  Transferring; and  Maintaining continence. This benefit is payable once per Covered Accident. Tendon/Ligament/Rotator Cuff: The tendon, ligament or rotator cuff must be torn, ruptured or severed and repaired through surgery within 12 months after a Covered Accident. The benefit amount varies based on the number of repairs required and the services received as shown on the SCHEDULE OF BENEFITS. This benefit is payable once per Covered Accident. Torn Hip, Knee, Shoulder Cartilage: You must receive surgical repair of torn hip, knee or shoulder cartilage. The Injury must be treated by a Doctor within 60 days after a Covered Accident. Surgical repair of the tear must occur within 6 months after the Covered Accident. The benefit amount varies based on the type of service received as shown on the SCHEDULE OF BENEFITS. This benefit is payable once per Covered Accident. If you receive more than one cartilage tear in a Covered Accident, a separate benefit is payable for each location (hip, knee, or shoulder) of the tear.

RL-ACC3-CERT2-23-IN 21 D12967 (11/25) Subsequent tears of the healing cartilage which occur after the original Covered Accident are not covered unless such tears are the result of Injuries received in a new and separate Covered Accident. ADDITIONAL BENEFIT(S) Sports Accident Benefit: An additional percentage of the Accident Hospital Care, Accident Care or Common Injuries benefit amount is payable if the Covered Accident is the result of participating in an organized sporting activity. “Organized sporting activity” for this benefit means an amateur sports competition or organized practice for an amateur sports competition. The activity must be overseen by an amateur sporting organization that oversees scholastic, recreational or social sports activities. This includes:  Participation in physical education as a class in a school setting.  Coaching, officiating or refereeing for an amateur sporting organization. Organized sporting activity does not include any activity that occurs before, between or after competitions or practices, including travel to or from a competition or practice. “Amateur sporting organization” means a public or private school, sports association, community recreational association or other organization that as part of its oversight does the following:  Sets up official rules and standards of play.  Arranges for officials to oversee competition.  Organizes inter-team competition, facilities and equipment.

RL-ACC3-CERT2-23-IN 22 D12967 (11/25) EXCLUSIONS We will not pay benefits for any Accident-related condition that is contributed to, caused by or results from the following:  Suicide, attempted suicide or any intentionally self-inflicted Injury, while sane or insane.  Any Sickness or declining process caused by a Sickness.  Participation or attempt to participate in a felony or illegal activity.  An Accident while you are operating a motorized vehicle while intoxicated. Intoxication means your blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the Accident occurred.  War or any act of war, whether declared or undeclared (excluding acts of terrorism).  Loss sustained while on active duty as a member of the armed forces of any nation. We will refund, upon Written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.  Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a Doctor.  Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.  Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded.  Engaging in hang-gliding, bungee jumping, parachuting, sailgliding, parasailing, parakiting, kitesurfing or any similar activities.  Practicing for, or participating in, any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received.  Work for pay, profit or gain. CLAIMS NOTICE OF CLAIM Written notice of your claim should be given to us within 30 days after the date of loss. The notice may be given to us at our home office or to our authorized administrator. Failure to give notice within this timeframe will not invalidate or reduce any payable claim if it can be shown that it was not reasonably possible to give such notice within that time and the notice was given as soon as reasonably possible. CLAIM FORM The claim form is available from the Employer or can be requested from us. If you do not receive the form from us within 15 days of your request, you may send us Written proof of claim without waiting for the form. If such Written proof of claim covers the occurrence, character and extent of the loss, and is provided within the time period below for proof of claim, you will be deemed to have complied with the requirements for providing proof of claim. FILING A CLAIM The claim form(s) may require completion by you and the Employer and your attending Doctor. The completed form(s) and any attachments indicated on the form(s) as required should be sent directly to us at the address indicated on the form. PROOF OF CLAIM You must send us Written proof of your claim within 90 days after the date of loss. Failure to give such proof within this timeframe will not invalidate or reduce any payable claim if it can be shown that it was not reasonably possible to give such proof within that time, and the proof was given as soon as reasonably possible. However, you must provide proof of claim no later than one year after the time proof is otherwise required, except in the absence of legal capacity.

RL-ACC3-CERT2-23-IN 23 D12967 (11/25) BENEFIT PAYMENTS Benefits are payable to you unless otherwise specified. Once a claim has been approved, we will make payment immediately upon receipt of due Written proof of claim. If any benefits are payable for loss of life, they will be paid in accordance with the beneficiary designation for such benefits and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, benefits payable for loss of life will be paid to your estate. All other benefits will be paid to you. PHYSICAL EXAMINATION We may require you to be examined by one or more Doctors or other medical practitioners of our choice. We will pay for this examination. We can require an examination as often as it is reasonable to do so while your claim is pending. We may also require you to be interviewed by our authorized representative. Failure to comply with this request may result in denial or termination of benefits. LEGAL ACTION You can start legal action regarding a claim no earlier than 60 days after Written proof of claim has been given to us, and no later than three years from the time proof of claim is required, unless otherwise provided under federal law. Nothing in this provision waives, extends or tolls any applicable statute of limitations governing any claim relating in any way to your coverage.

RL-ACC3-SPR2-23-IN 1 SPR-12967 (11/25) SPOUSE ACCIDENT 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..................................................................................... 1 General Provisions........................................................................ 2 Accident Benefits.................................................................. 4 Exclusions .................................................................................... 4 Claims.......................................................................................... 4 SCHEDULE OF BENEFITS WHO PAYS FOR THE COVERAGE You pay the cost of coverage under this rider. ACCIDENT BENEFITS The benefit amounts for your Spouse are the same as the benefit amounts for you as shown on the SCHEDULE OF BENEFITS section of the Certificate, based on your Spouse’s Covered Accident. DEFINITIONS General terms defined in the DEFINITIONS section of the Certificate regarding medical conditions and eligibility apply to your Spouse. Spouse means your lawful spouse.

RL-ACC3-SPR2-23-IN 2 SPR-12967 (11/25) GENERAL PROVISIONS ELIGIBILITY If you are covered under the Policy, then your Spouse is eligible 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.  The date of your marriage. If your Spouse is covered under the Policy as an Employee, then your Spouse is not eligible for coverage under this rider. ENROLLMENT If you have a Spouse eligible for Spouse coverage, you must enroll for any Spouse coverage before it will become effective. The Employer or we will provide you with the forms or information needed to complete your enrollment. You may enroll for Spouse coverage when you become newly eligible, or following a qualifying life event as allowed by the Employer, or during an enrollment period chosen by the Employer and approved by us. EFFECTIVE DATE OF COVERAGE Your Spouse will be covered at 12:01 a.m. standard time at the Policyholder’s address on the latest of the following:  The date your Spouse is eligible for coverage, if you enroll for Spouse coverage on or before that date.  The first day of the month that is on or next follows the date you enroll for Spouse coverage.  The first day of the month that is on or next follows the date you return to Active Employment, if you are not in Active Employment when your Spouse’s coverage would otherwise become effective. Exception: Coverage starts on a non-working day if you were in Active Employment on your last scheduled working day before the non- working day. Non-working days include time off for the following: vacations, personal holidays, weekends and holidays, approved nonmedical leave of absence and paid time off for nonmedical-related absences. EFFECTIVE DATE OF CHANGES TO COVERAGE Once your Spouse’s coverage begins, any increased or additional coverage will take effect on the latest of the following:  The date of the increased or additional coverage, if you are in Active Employment.  The date you return to Active Employment, if you are not in Active Employment due to injury or sickness. Any decrease in coverage will take effect immediately but will not affect a payable claim that occurs prior to the decrease. TERMINATION OF COVERAGE Coverage for your Spouse under this rider ends on the earliest of the following:  The date your Accident insurance terminates. See the PORTABILITY FOLLOWING DEATH OR DIVORCE provision below if termination is due to death or involves Spouse 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 regarding Spouse coverage previously continued by you or your Spouse.  The date coverage under this rider is terminated for the eligible class of Active Employees to which you belong. See the PORTABILITY provisions below regarding Spouse coverage previously continued by you or your Spouse.  The date you voluntarily cancel coverage under this rider.  The date your Spouse is no longer an eligible Spouse as defined by this rider. See the PORTABILITY FOLLOWING DEATH OR DIVORCE provision below.  The end of the period for which premiums for this rider are paid, if the next premium is not paid by its due date, subject to the GRACE PERIOD provision. We will pay benefits for a loss that occurs while your Spouse is insured under this rider even if the rider has since terminated.

RL-ACC3-SPR2-23-IN 3 SPR-12967 (11/25) PORTABILITY If you continue your coverage under the Certificate’s PORTABILITY provision, then your Spouse’s coverage under this rider may also be continued at the same time. Continued premium payment is required to keep your Spouse’s coverage in force. You may decrease the continued Spouse coverage amount based on the available amounts on the Certificate’s SCHEDULE OF BENEFITS. You may not increase the continued Spouse coverage amount. Continued Spouse coverage under this provision is subject to all the terms of this rider. PORTABILITY FOLLOWING DEATH OR DIVORCE If you die or divorce, your Spouse may elect to continue Spouse coverage under this rider if certain conditions are met. Your Spouse must have been insured under this rider on the date of your death or divorce, your Spouse must be under age 75, and your Spouse must elect portability and pay the first premium within 31 days of the date of your death or divorce. If your Spouse continues coverage under this provision, your Spouse will become the owner of their Spouse coverage under this rider. Your Spouse may decrease the continued Spouse coverage amount based on the amounts available on the Certificate’s SCHEDULE OF BENEFITS. Your Spouse may not increase the continued Spouse coverage amount. Coverage continued under this provision is subject to all the terms of this rider. Premiums will be billed directly to your Spouse. Continued premium payment is required to keep coverage in force. The initial premium will be based on the portability premium rates in effect at the time your Spouse elects portability. We may change the portability premium rates at any time upon 31 days Written notice to your Spouse. Coverage continued under this provision will end on the earliest of the following:  The end of the period for which premiums for this rider are paid if the next premium is not paid by its due date, subject to the GRACE PERIOD provision.  The date your Spouse attains age 75.  The date your Spouse voluntarily cancels coverage under this rider.  The date your Spouse dies.  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. GRACE PERIOD Refer to the GRACE PERIOD provision in the Certificate if you are continuing coverage under the Certificate’s PORTABILITY provision. If your Spouse is continuing coverage under the PORTABILITY FOLLOWING DEATH OR DIVORCE provision, your Spouse has a grace period of 60 days for the payment of any premium due. During this grace period, your Spouse’s coverage will remain in force. If the full premium payment is not received by us by the due date, we will give Written notification to your Spouse that if the premium is not paid by the end of the grace period, then all coverage under this rider will terminate on the last day of the grace period. If we fail to give such Written notice, coverage will continue in effect until the date such notice is given. We may extend the grace period by giving Written notice of such intent to your Spouse, and such notice will specify that all coverage will terminate on that date if the premium remains unpaid. A pro rata premium payment is required for any period your Spouse’s coverage was in force during the grace period.

RL-ACC3-SPR2-23-IN 4 SPR-12967 (11/25) CLAIMS A claimant includes you or your Spouse if your Spouse has continued coverage under a PORTABILITY provision. NOTICE OF CLAIM Notice of claim should be given to us within 30 days after the date of loss. The notice may be given to us at our home office or to our authorized administrator. Failure to give notice within this timeframe will not invalidate or reduce any payable claim if it can be shown that it was not reasonably possible to give such notice within that time and the notice was given as soon as reasonably possible. CLAIM FORM The claim form is available from the Employer or can be requested from us. If the form is not received from us within 15 days of the request, Written proof of claim may be sent to us without waiting for the form. If such Written proof of claim covers the occurrence, character and extent of the loss, and is provided within the time period below for proof of claim, the claimant will be deemed to have complied with the requirements for providing proof of claim. FILING A CLAIM The claim form(s) may require completion by the claimant and the Employer and your Spouse’s attending Doctor. The completed form(s) and any attachments indicated on the form(s) as required should be sent directly to us at the address indicated on the form. ACCIDENT BENEFITS Benefit amounts for your Spouse are the same as the benefit amounts for you as shown on the Certificate’s SCHEDULE OF BENEFITS. We will pay benefits if your Spouse receives any of the services or meets any of the conditions described in the ACCIDENT BENEFITS sections of the Certificate, as the result of Injuries received in a Covered Accident. The Injury must occur while your Spouse is covered under the Policy. Only one family care benefit is payable per eligible family member if you and your Spouse are simultaneously Confined in a Hospital or a Critical Care Unit or a Rehabilitation Facility. EXCLUSIONS We will not pay benefits for any Accident-related condition that is contributed to, caused by or results from the following:  Suicide, attempted suicide or any intentionally self-inflicted Injury, while sane or insane.  Any Sickness or declining process caused by a Sickness.  Participation or attempt to participate in a felony or illegal activity.  An Accident while your Spouse is operating a motorized vehicle while intoxicated. Intoxication means your Spouse’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the Accident occurred.  War or any act of war, whether declared or undeclared (excluding acts of terrorism).  Loss sustained while on active duty as a member of the armed forces of any nation. We will refund, upon Written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.  Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a Doctor.  Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.  Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded.  Engaging in hang-gliding, bungee jumping, parachuting, sailgliding, parasailing, parakiting, kitesurfing or any similar activities.  Practicing for, or participating in, any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received.  Work for pay, profit or gain.

RL-ACC3-SPR2-23-IN 5 SPR-12967 (11/25) PROOF OF CLAIM Written proof of claim must be sent to us within 90 days after the date of loss. Failure to give such proof within this timeframe will not invalidate or reduce any payable claim if it can be shown that it was not reasonably possible to give such proof within that time, and the proof was given as soon as reasonably possible. However, proof of claim must be provided no later than one year after the time proof is otherwise required, except in the absence of legal capacity. PHYSICAL EXAMINATION We may require your Spouse to be examined by one or more Doctors or other medical practitioners of our choice. We will pay for this examination. We can require an examination as often as it is reasonable to do so while the claim is pending. We may also require your Spouse to be interviewed by our authorized representative. Failure to comply with this request may result in denial or termination of benefits. BENEFIT PAYMENTS Benefits under this rider are payable to you unless otherwise specified. Once a claim has been approved, we will make payment immediately upon receipt of due Written proof of claim. Any accrued benefits that are payable at your death will be paid according to the BENEFIT PAYMENTS provision in the Certificate. For PORTABILITY FOLLOWING DEATH OR DIVORCE, benefits are payable to your Spouse, and any accrued benefits that are payable at the time of your Spouse’s death will be paid to your Spouse’s estate. Any payment we make in good faith will discharge our liability as to the extent of such payment. We will pay the benefits in one sum or in a method comparable to one sum. Executed at our home office: 250 Marquette Avenue Suite 900 Minneapolis, MN 55401 Amelia (Amy) J. Vaillancourt Melissa A. O'Donnell President Secretary LEGAL ACTION A claimant can start legal action regarding a claim no earlier than 60 days after Written proof of claim has been given to us, and no later than three years from the time proof of claim is required, unless otherwise provided under federal law. Nothing in this provision waives, extends or tolls any applicable statute of limitations governing any claim relating in any way to your Spouse’s coverage.

RL-ACC3-CHR2-23-IN 1 CHR-12967 (11/25) CHILDREN'S ACCIDENT 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.............................................................................................. 1 General Provisions................................................................................. 2 Accident Benefits........................................................................... 5 Exclusions.............................................................................................. 5 Claims.................................................................................................... 5 DEFINITIONS General terms defined in the DEFINITIONS section of the Certificate regarding medical conditions and eligibility apply to your Children. Child or Children means a child from birth but less than 26 years of age who is one of the following:  Your natural or adopted child from the earlier of the date of placement or order granting custody.  Your stepchild.  A child or grandchild for whom you are a legal guardian.  Your foster child. The child must also meet all of the following conditions:  Not be on full-time active duty in the armed forces of any country or subdivision thereof.  Not be insured under the Policy as an Employee or Spouse. SCHEDULE OF BENEFITS WHO PAYS FOR THE COVERAGE You pay the cost of coverage under this rider. ACCIDENT BENEFITS The benefit amounts for your Children are the same as the benefit amounts for you as shown on the SCHEDULE OF BENEFITS section of the Certificate, based on your Child’s Covered Accident.

RL-ACC3-CHR2-23-IN 2 CHR-12967 (11/25) This definition includes your Child age 26 or older who is incapable of self-sustaining employment due to physical or intellectual disability. Written proof of the Child's incapacity must be furnished to us at our home office within 31 days after the Child reaches age 26. We may require, at reasonable intervals, but not more than once a year after the two year period following attainment of the limiting age, evidence satisfactory to us that the incapacity is continuing. Coverage will continue while the Child remains incapable of self-sustaining employment due to physical or intellectual disability and continues to meet the definition of Child except for the age limit. Spouse means your lawful spouse. GENERAL PROVISIONS ELIGIBILITY If you are covered under the Policy, then your Children are eligible 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.  The date you acquire a Child by marriage, birth or adoption. If both you and your Spouse are covered under the Policy as an Employee, then only one of you may cover your Children under this rider. If the parent who is covering the Children stops being insured as an Employee then the other parent may enroll for Children’s coverage under this rider within 60 days. ENROLLMENT If you have a Child or Children eligible for coverage, you must enroll for any coverage before it will become effective. You may enroll for Children’s coverage when you become newly eligible, or following a qualifying life event as allowed by the Employer, or during an enrollment period chosen by the Employer and approved by us. The Employer or we will provide you with the forms or information needed to complete your enrollment. EFFECTIVE DATE OF COVERAGE Your Children will be covered at 12:01 a.m. standard time at the Policyholder’s address on the latest of the following:  The date your Children are eligible for coverage, if you enroll for Children’s coverage on or before that date.  The first day of the month that is on or next follows the date you enroll for Children’s coverage.  The first day of the month that is on or next follows the date you return to Active Employment, if you are not in Active Employment when your Children’s coverage would otherwise become effective. Exception: Coverage starts on a non-working day if you were in Active Employment on your last scheduled working day before the non-working day. Non-working days include time off for the following: vacations, personal holidays, weekends and holidays, approved nonmedical leave of absence and paid time off for non-medical-related absences. If you have coverage under this rider and you acquire a new eligible Child due to birth, marriage or adoption, then the newly eligible Child will be covered automatically from the date of the event. If an adopted newborn Child is placed with you within 30 days of birth, the “event” will be the date of birth. If an adopted Child is placed with you more than 30 days after birth, the “event” will be the date of placement. No additional premium is required. EFFECTIVE DATE OF CHANGES TO COVERAGE Once your Children’s coverage begins, any increased or additional coverage will take effect on the latest of the following:  The date of the increased or additional coverage, if you are in Active Employment.  The date you return to Active Employment, if you are not in Active Employment due to injury or sickness. Any decrease in coverage will take effect immediately but will not affect a payable claim that occurs prior to the decrease.

RL-ACC3-CHR2-23-IN 3 CHR-12967 (11/25) TERMINATION OF COVERAGE Coverage for each of your Children under this rider ends on the earliest of the following:  The date the Child is no longer an eligible Child as defined by this rider. Eligibility of a Child who is incapable of self-sustaining employment due to physical or intellectual disability ends when there is no longer evidence satisfactory to us that the incapacity is continuing.  The date coverage for all your Children ends as described below. Coverage for all your Children under this rider ends on the earliest of the following:  The date your Accident insurance terminates. See the PORTABILITY FOLLOWING DEATH provision below if termination is due to death.  The date coverage under this rider is terminated for all Active Employees under the Policy. See the PORTABILITY provisions below regarding Children’s coverage previously continued by you or your Spouse.  The date coverage under this rider is terminated for the eligible class of Active Employees to which you belong. See the PORTABILITY provisions below regarding Children’s coverage previously continued by you or your Spouse.  The date you voluntarily cancel coverage under this rider.  The date you no longer have any eligible Children as defined by this rider.  The end of the period for which premiums for this rider are paid, if the next premium is not paid by its due date, subject to the GRACE PERIOD provision. We will pay benefits for a loss that occurs while your Child is insured under this rider even if this rider has since terminated. PORTABILITY If you continue your coverage under the Certificate’s PORTABILITY provision, then your Children’s coverage under this rider may also be continued at the same time. Continued premium payment is required to keep your Children’s coverage in force. You may decrease the continued Children’s coverage amount based on the available amounts on the Certificate’s SCHEDULE OF BENEFITS. You may not increase the continued Children’s coverage amount. Continued Children’s coverage under this provision is subject to all the terms of this rider. PORTABILITY FOLLOWING DEATH If you die and your Spouse continues coverage under the PORTABILITY FOLLOWING DEATH OR DIVORCE provision of the Spouse Accident Rider, then Children’s coverage under this rider may be continued at the same time under your Spouse’s coverage. After continuing coverage under this rider, each Child will be covered only if they would have been eligible for coverage under the eligibility rules in force prior to the death of the Employee. If your Spouse continues coverage under this provision, your Spouse will become the owner of the Children’s coverage under this rider. Your Spouse may decrease the continued Children’s coverage amount based on the amounts available on the Certificate’s SCHEDULE OF BENEFITS. Your Spouse may not increase the continued Children’s coverage amount. Coverage continued under this provision is subject to all the terms of this rider. Premiums will be billed directly to your Spouse. Continued premium payment is required to keep coverage in force. The initial premium will be based on the portability premium rates in effect at the time your Spouse elects portability. We may change the portability premium rates at any time upon 31 days Written notice to your Spouse. Coverage continued under this provision will end on the earliest of the following:  The end of the period for which premiums for this rider are paid, if the next premium is not paid by its due date, subject to the GRACE PERIOD provision.  The date your Spouse voluntarily cancels coverage under this rider.  The date your Spouse’s coverage under the Spouse Accident Rider terminates.  The date there are no longer any eligible Children as defined by this rider.  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.

RL-ACC3-CHR2-23-IN 4 CHR-12967 (11/25) GRACE PERIOD Refer to the GRACE PERIOD provision in the Certificate if you are continuing coverage under the Certificate’s PORTABILITY provision. If your Spouse is continuing Children’s coverage under the PORTABILITY FOLLOWING DEATH provision, your Spouse has a grace period of 60 days for the payment of any premium due. During this grace period, your Children’s coverage will remain in force. If the full premium payment is not received by us by the due date, we will give Written notification to your Spouse that if the premium is not paid by the end of the grace period, then all coverage under this rider will terminate on the last day of the grace period. If we fail to give such Written notice, coverage will continue in effect until the date such notice is given. We may extend the grace period by giving Written notice of such intent to your Spouse, and such notice will specify that all coverage will terminate on that date if the premium remains unpaid. A pro rata premium payment is required for any period your Children’s coverage was in force during the grace period.

RL-ACC3-CHR2-23-IN 5 CHR-12967 (11/25) ACCIDENT BENEFITS Benefit amounts for your Children are the same as the benefit amounts for you as shown on the Certificate’s SCHEDULE OF BENEFITS. We will pay benefits if your Child receives any of the services or meets any of the conditions described in the ACCIDENT BENEFITS sections of the Certificate, as the result of Injuries received in a Covered Accident. The Injury must occur while your Child is covered under the Policy. Benefits are payable for each covered Child. No family care benefit is payable for your Child’s Covered Accident. EXCLUSIONS We will not pay benefits for any Accident-related condition that is contributed to, caused by or results from the following:  Suicide, attempted suicide or any intentionally self-inflicted Injury, while sane or insane.  Any Sickness or declining process caused by a Sickness.  Participation or attempt to participate in a felony or illegal activity.  An Accident while your Child is operating a motorized vehicle while intoxicated. Intoxication means your Child’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the Accident occurred.  War or any act of war, whether declared or undeclared (excluding acts of terrorism).  Loss sustained while on active duty as a member of the armed forces of any nation. We will refund, upon Written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.  Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a Doctor.  Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.  Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded.  Engaging in hang-gliding, bungee jumping, parachuting, sailgliding, parasailing, parakiting, kitesurfing or any similar activities.  Practicing for, or participating in, any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received.  Work for pay, profit or gain. CLAIMS A claimant includes you or your Spouse if your Spouse has continued coverage under the PORTABILITY FOLLOWING DEATH provision. NOTICE OF CLAIM Notice of claim should be given to us within 30 days after the date of loss. The notice may be given to us at our home office or to our authorized administrator. Failure to give notice within this timeframe will not invalidate or reduce any payable claim if it can be shown that it was not reasonably possible to give such notice within that time and the notice was given as soon as reasonably possible. CLAIM FORM The claim form is available from the Employer or can be requested from us. If the form is not received from us within 15 days of the request, Written proof of claim may be sent to us without waiting for the form. If such Written proof of claim covers the occurrence, character and extent of the loss, and is provided within the time period below for proof of claim, the claimant will be deemed to have complied with the requirements for providing proof of claim. FILING A CLAIM The claim form(s) may require completion by the claimant and the Employer and your Child’s attending Doctor. The completed form(s) and any attachments indicated on the form(s) as required should be sent directly to us at the address indicated on the form.

RL-ACC3-CHR2-23-IN 6 CHR-12967 (11/25) PROOF OF CLAIM Written proof of claim must be sent to us within 90 days after the date of loss. Failure to give such proof within this timeframe will not invalidate or reduce any payable claim if it can be shown that it was not reasonably possible to give such proof within that time, and the proof was given as soon as reasonably possible. However, proof of claim must be provided no later than one year after the time proof is otherwise required, except in the absence of legal capacity. PHYSICAL EXAMINATION We may require your Child to be examined by one or more Doctors or other medical practitioners of our choice. We will pay for this examination. We can require an examination as often as it is reasonable to do so while the claim is pending. We may also require the claimant to be interviewed by our authorized representative. Failure to comply with this request may result in denial or termination of benefits. BENEFIT PAYMENTS Benefits under this rider are payable to you. Once a claim has been approved, we will make payment immediately upon receipt of due Written proof of claim. Any accrued benefits that are payable at your death will be paid according to the BENEFIT PAYMENTS provision in the Certificate. For PORTABILITY FOLLOWING DEATH, any accrued benefits that are payable at the time of your Spouse’s death will be paid to your Spouse’s estate. Any payment we make in good faith will discharge our liability as to the extent of such payment. We will pay the benefits in one sum or in a method comparable to one sum. LEGAL ACTION A claimant can start legal action regarding a claim no earlier than 60 days after Written proof of claim has been given to us, and no later than three years from the time proof of claim is required, unless otherwise provided under federal law. Nothing in this provision waives, extends or tolls any applicable statute of limitations governing any claim relating in any way to your Children’s coverage. Executed at our home office: 250 Marquette Avenue Suite 900 Minneapolis, MN 55401 Amelia (Amy) J. Vaillancourt Melissa A. O'Donnell President Secretary

RL-ACC3-CNT2-23-IN 1 CNT-12967 (11/25) DEFINITIONS 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. Leave of Absence means you are absent from Active Employment for a period of time under a leave granted in Writing by the Employer that is in accordance with the Employer’s formal leave policies. Normal vacation time is not considered a Leave of Absence. Labor Strike means you are absent from Active Employment for a period of time for which continuation of insurance is available under the Employer’s Written plan for labor strikes. Temporary Layoff means you are absent from Active Employment and no longer an Employee of the Employer for a limited period of time for which continuation of insurance is available under the Employer’s formal policy for temporary layoffs, and the layoff is not intended to be permanent. Total Disability or Totally Disabled means that due to an injury or sickness you are unable to perform the material duties of your regular occupation, and you are unable to perform any other occupation for which you are fit by education, training or experience. CONTINUATION OF INSURANCE 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 Definitions............................................................................. 1 General Provisions................................................................ 2 Continuation of Insurance...................................................... 2

RL-ACC3-CNT2-23-IN 2 CNT-12967 (11/25) 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. EFFECTIVE DATE You will be covered at 12:01 a.m. standard time at the Policyholder’s address on the date you are eligible for coverage under this rider. CHANGE OF INSURANCE CARRIERS The CHANGE OF INSURANCE CARRIERS provision in the Certificate is revised to include an Employee whose coverage was being continued under a similar continuation provision in the Employer’s prior group policy of accident insurance at the time the Employer’s coverage under our Policy became effective. TERMINATION Coverage under this rider ends on the earliest of the following:  The date your Accident insurance terminates.  The date coverage under this rider is terminated for all Active Employees under the Policy.  The date coverage under this rider is terminated for the eligible class of Active Employees to which you belong. PORTABILITY If you continue your coverage under the Certificate’s PORTABILITY provision, that continuation will not include this rider. EMPLOYER-APPROVED LEAVE(S) OF ABSENCE Family and Medical Leave If you are on a Leave of Absence as described under the Family and Medical Leave Act of 1993 and any amendments ("FMLA") or applicable state family and medical leave law ("State FML"), and the Employer's human resource policy provides for continuation of insurance during a FMLA or State FML Leave of Absence, then insurance coverage for all Covered Persons may be continued until the end of the later of:  The leave period permitted by FMLA.  The leave period permitted by State FML. CONTINUATION OF INSURANCE If you stop Active Employment due to:  Employer-approved Leave of Absence, or  Total Disability, or  Temporary Layoff, or  Labor Strike, then coverage may be continued under the Policy beyond the date you are no longer in Active Employment, limited to the time period(s) described below. During this continued coverage period, the amount of continued insurance equals the amount in effect the day prior to the continuation period. That amount will reduce or terminate according to the Certificate and riders in effect the day prior to the continuation period. Premiums are due during the continuation period on the same basis as on the day prior to the continuation period. Contact the Employer for more information. If an eligible claim occurs while coverage is being continued under this rider, then benefits will be payable as described in the Certificate and riders.

RL-ACC3-CNT2-23-IN 3 CNT-12967 (11/25) This continuation of coverage includes all riders that were in effect on the date before the FMLA or State FML Leave of Absence began. Sickness or Injury If you are on a Leave of Absence due to your sickness or injury, including Total Disability, then insurance coverage for all Covered Persons may be continued under this rider until the earliest of the following:  The last day of the month which is on or next follows the date your approved Leave of Absence ends.  The last day of the month which is on or next follows the date which is 9 months after the date you stopped Active Employment. This continuation of coverage includes all riders that were in effect on the date before the Leave of Absence began. TEMPORARY LAYOFF If you stop Active Employment due to a Temporary Layoff, then insurance coverage for all Covered Persons may be continued under this rider until the earliest of the following:  The last day of the month which is on or next follows the date your Temporary Layoff ends.  The last day of the month which is on or next follows the date which is 2 months after the date you stopped Active Employment. This continuation of coverage includes all riders that were in effect on the date before the Leave of Absence began. LABOR STRIKE If you stop Active Employment due to a Labor Strike, then insurance coverage for all Covered Persons may be continued under this rider until earliest of the following:  The last day of the month which is on or next follows the end of the Labor Strike period.  The last day of the month which is on or next follows the date which is 2 months after the date you stopped Active Employment. This continuation of coverage includes all riders that were in effect on the date before the Leave of Absence began. CONCURRENT LEAVES OF ABSENCE If you would be eligible for more than one type of continuation under this rider during any one period that you are not in Active Employment, we will consider such periods to be concurrent for the purpose of determining how long your coverage may continue under the Policy. TERMINATION OF CONTINUATION Coverage continued under this rider will end on the earliest of the following:  The end of the continuation period as indicated above.  The date coverage under this rider is terminated for all Active Employees under the Policy.  The date coverage under this rider is terminated for the eligible class of Active Employees to which you belong.  The end of the period for which premiums are paid, if the next premium is not paid by its due date, subject to the GRACE PERIOD provision.  The date you are eligible under the Policy as an Active Employee.  The date of your death.  The date you become covered under another group accident insurance policy as an employee or member. In no event will coverage for any Covered Person be continued beyond the date coverage would otherwise end according to the termination provision(s) of the Certificate and riders. Other Leave of Absence If you are on a Leave of Absence for any other reason, then insurance coverage for all Covered Persons may be continued under this rider until the earliest of the following:  The last day of the month which is on or next follows the date your approved Leave of Absence ends.  The last day of the month which is on or next follows the date which is 60 days after the date you stopped Active Employment. This continuation of coverage includes all riders that were in effect on the date before the Leave of Absence began.

RL-ACC3-CNT2-23-IN 4 CNT-12967 (11/25) When this continuation ends, insurance under the Policy will stay in force only if all of the following conditions are met:  Accident insurance is in force for Active Employees under the Policy;  You are in an eligible class for coverage under the Policy; and  Your premium payments are resumed. The amount of insurance will be subject to the Certificate and riders in effect on the date your premium payments are resumed. RETURN TO ACTIVE EMPLOYMENT If coverage is not continued during your Leave of Absence for active military service, and you return to Active Employment while coverage is in force for Active Employees under the Policy, then coverage for all Covered Persons may be reinstated in accordance with USERRA and applicable state law. If coverage is not continued during any other period that is eligible for continuation under the Policy, and you return to Active Employment while coverage is in force for Active Employees under the Policy, then the terms of the Certificate and riders will apply. PORTABILITY FOLLOWING TERMINATION OF CONTINUATION When continuation under this rider ends, continued premium payment will be required to keep coverage in force. If you are not eligible as an Active Employee on that date, then your coverage can be continued under the Certificate’s PORTABILITY provision. See the PORTABILITY provisions of the Spouse Accident Rider and Children’s Accident Rider for information about continuing coverage after your death or divorce. Executed at our home office: 250 Marquette Avenue Suite 900 Minneapolis, MN 55401 Amelia (Amy) J. Vaillancourt Melissa A. O'Donnell President Secretary

RL-ACC3-WELL2-23-IN 1 WELL-12967 (11/25) WELLNESS BENEFIT You: $100 Your Spouse: $100 Your Children: 100% of your wellness benefit amount per Child A wellness benefit is payable up to a maximum of one time per Covered Person per calendar year. DEFINITIONS General terms are defined in the DEFINITIONS section of the Certificate and riders. 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. WELLNESS BENEFIT 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................................................................................. 1 General Provisions.................................................................... 2 Benefits..................................................................................... 3 Exclusions................................................................................. 3 Claims....................................................................................... 3 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.

RL-ACC3-WELL2-23-IN 2 WELL-12967 (11/25) GENERAL PROVISIONS ELIGIBILITY If you are covered under the Policy, then you are eligible 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 terminate 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. PORTABILITY If you continue your coverage under the Certificate’s PORTABILITY provision, then coverage under this rider will also be continued during portability. Continued coverage under this provision is subject to all the terms of this rider. ASSIGNMENT At the time of claim under this rider, you can assign the payment of a benefit under this rider to a third party who is not the Policyholder. PORTABILITY FOLLOWING DEATH OR DIVORCE If you die or divorce and your Spouse continues coverage under the PORTABILITY FOLLOWING DEATH OR DIVORCE provision of the Spouse Accident Rider, then coverage under this rider can also be continued under your Spouse’s coverage. Continued coverage under this provision is subject to all the terms of this rider.

RL-ACC3-WELL2-23-IN 3 WELL-12967 (11/25) EXCLUSIONS The EXCLUSIONS section of the Certificate and riders does not apply to this rider. CLAIMS The PHYSICAL EXAMINATION provision does not apply to this rider. A claimant includes you or your Spouse if your Spouse has continued coverage under a PORTABILITY provision. NOTICE OF CLAIM Notice of claim must be given to us during the same calendar year the health screening test occurs or within 30 days of the end of the calendar year, whichever is later. The notice may be given to us at our home office or to our authorized administrator. Failure to give notice within this timeframe will not invalidate or reduce any payable claim if it can be shown that it was not reasonably possible to give such notice within that time and the notice was given as soon as reasonably possible. CLAIM FORM The claim form is available from the Employer or can be requested from us. If the form is not received from us within 15 days of the request, Written proof of claim may be sent to us without waiting for the form. If such Written proof of claim covers the occurrence, character and description of the health screening test, and is provided within the time period below for proof of claim, the claimant will be deemed to have complied with the requirements for providing proof of claim. FILING A CLAIM The claim form(s) may require completion by the claimant and the Employer and the Covered Person's attending Doctor. The completed form(s) and any attachments indicated on the form(s) as required should be sent directly to us at the address indicated on the form. PROOF OF CLAIM Written proof of claim must be sent to us within 90 days after the date of the health screening test. Failure to give such proof within this timeframe will not invalidate or reduce any payable claim if it can be shown that it was not reasonably possible to give such proof within that time, and the proof was given as soon as reasonably possible. However, proof of claim must be provided no later than one year after the time proof is otherwise required, except in the absence of legal capacity. BENEFITS We will pay you a WELLNESS benefit as shown on the SCHEDULE OF BENEFITS if a Covered Person has a health screening test on or after the Covered Person’s coverage effective date. A benefit is payable up to a maximum of one time per Covered Person per calendar year. The amounts are shown on the SCHEDULE OF BENEFITS. Health screening tests include, but are not limited to:  Blood test for triglycerides  Pap smear or thin prep pap test;  Flexible sigmoidoscopy  CEA (blood test for colon cancer)  Bone marrow testing  Serum cholesterol test for HDL & LDL levels  Hemoccult stool analysis  Serum Protein Electrophoresis (myeloma)  Breast ultrasound, sonogram, MRI  Chest x-ray  Mammography  Colonoscopy  CA 15-3 (breast cancer)  Stress test on bicycle or treadmill  Fasting blood glucose test  Thermography  PSA (prostate cancer)  Electrocardiogram (EKG)  Endoscopy  Carotid Doppler  Routine Eye exam  Routine dental exam  Well child/preventive exams for ages 1 through age 18  Biometric screenings  Molecular or antigen test (Coronavirus)

RL-ACC3-WELL2-23-IN 4 WELL-12967 (11/25) BENEFIT PAYMENTS Benefits under this rider are payable to you unless otherwise specified. Once a claim has been approved, we will make payment immediately upon receipt of due Written proof of claim. Any accrued benefits that are payable at your death will be paid according to the BENEFIT PAYMENTS provision in the Certificate. For PORTABILITY FOLLOWING DEATH OR DIVORCE, benefits are payable to your Spouse, and any accrued benefits that are payable at the time of your Spouse’s death will be paid to your Spouse’s estate. Any payment we make in good faith will discharge our liability as to the extent of such payment. We will pay the benefits in one sum. Executed at our home office: 250 Marquette Avenue Suite 900 Minneapolis, MN 55401 Amelia (Amy) J. Vaillancourt Melissa A. O'Donnell President Secretary LEGAL ACTION A claimant can start legal action regarding a claim no earlier than 60 days after Written proof of claim has been given to us, and no later than three years from the time proof of claim is required, unless otherwise provided under federal law. Nothing in this provision waives, extends or tolls any applicable statute of limitations governing any claim relating in any way to the coverage.

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

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.

RL-ACC3-ADR2-23-IN 3 ADR-12967 (11/25) PORTABILITY If you continue your coverage under the Certificate’s PORTABILITY provision, then coverage under this rider will also be continued during portability. Continued coverage under this provision is subject to all the terms of this rider. AD&D BENEFITS We will pay an AD&D benefit as shown on the SCHEDULE OF BENEFITS if a Covered Person meets any of the conditions described below as the result of Injuries received in a Covered Accident. The Injury must occur, and the loss resulting from the Injury must begin, while the Covered Person is covered under this rider. Accidental Death: A benefit is payable if Injuries received in a Covered Accident cause a Covered Person’s death within 90 days after the Covered Accident. Your benefit is payable to your named Accidental death beneficiary. If there is no named beneficiary, benefits will be paid according to the BENEFIT PAYMENTS provision in the Certificate. Your Spouse's and Child's benefit is payable to you. Note: No Accidental death benefit is payable if the Covered Person is eligible for the common carrier benefit. Common Carrier: A benefit is payable if Injuries received in a Covered Accident occur while a Covered Person is a fare paying passenger in a common carrier, and the Injuries cause the Covered Person’s death within 90 days after the Covered Accident. Your benefit is payable to your named Accidental death beneficiary. If there is no named beneficiary, benefits will be paid according to the BENEFIT PAYMENTS provision in the Certificate. Your Spouse's and Child's benefit is payable to you. “Common carrier” for this benefit means any commercial transportation that operates on a regularly scheduled basis between predetermined points or cities. Dismemberment: A benefit is payable to you if a Covered Person’s loss (as described below) occurs within 90 days after a Covered Accident. The benefit amount varies based on the type of loss as shown on the SCHEDULE OF BENEFITS. The types of eligible loss under this benefit are limited to the following:  Loss of both hands.  Loss of both feet.  Total and permanent loss of sight in both eyes.  Loss of one hand or one foot AND permanent loss of sight in one eye.  Loss of one hand AND one foot.  Loss of one hand OR one foot.  Loss of two or more fingers or toes.  Loss of one finger OR one toe. “Loss” for this benefit means the physical loss of:  A hand: the hand is removed through or above the wrist joint.  A foot: the foot is removed through or above the ankle joint.  Sight in an eye: total and permanent loss of sight.  A finger: the finger is removed at the joint proximate to the first interphalangeal joint where it is attached to the hand.  A toe: the toe is removed at the joint proximate to the first interphalangeal joint where it is attached to the foot. If a Covered Person loses a finger or toe, and within 90 days of that loss, loses a hand or foot on the same side of the body as the result of the same Covered Accident, the benefit amount payable for the loss of the finger or toe will be subtracted from the benefit payable for the loss of the hand or the foot. If an Accident benefit is payable after laceration repair of a finger, toe, hand, foot or eye and that body part is later lost due to the same Covered Accident, the amount of the laceration repair benefit will be subtracted from the dismemberment benefit. PORTABILITY FOLLOWING DEATH OR DIVORCE If you die or divorce and your Spouse continues portability under the PORTABILITY FOLLOWING DEATH OR DIVORCE provision of the Spouse Accident Rider, then coverage under this rider will also be continued under your Spouse’s coverage. Continued coverage under this provision is subject to all the terms of this rider.

RL-ACC3-ADR2-23-IN 4 ADR-12967 (11/25) CLAIMS A claimant includes you, or in the case of your death, a named Accidental death beneficiary. If there is no named beneficiary, a claimant includes the person eligible for benefits according to the BENEFIT PAYMENTS provision in the Certificate. A claimant may also include your Spouse if your Spouse has continued coverage under a PORTABILITY provision. NOTICE OF CLAIM Notice of claim should be given to us within 30 days after the date of loss. The notice may be given to us at our home office or to our authorized administrator. Failure to give notice within this timeframe will not invalidate or reduce any payable claim if it can be shown that it was not reasonably possible to give such notice within that time and the notice was given as soon as reasonably possible. CLAIM FORM The claim form is available from the Employer or can be requested from us. If the form is not received from us within 15 days of the request, Written proof of claim may be sent to us without waiting for the form. If such Written proof of claim covers the occurrence, character and extent of the loss, and is provided within the time period below for proof of claim, the claimant will be deemed to have complied with the requirements for providing proof of claim. FILING A CLAIM The claim form(s) may require completion by the claimant and the Employer and the Covered Person’s attending Doctor. The completed form(s) and any attachments indicated on the form(s) as required should be sent directly to us at the address indicated on the form. PROOF OF CLAIM Written proof of claim must be sent to us within 90 days after the date of loss. Failure to give such proof within this timeframe will not invalidate or reduce any payable claim if it can be shown that it was not reasonably possible to give such proof within that time, and the proof was given as soon as reasonably possible. However, proof of claim must be provided no later than one year after the time proof is otherwise required, except in the absence of legal capacity. EXCLUSIONS We will not pay benefits for any Accident-related condition that is contributed to, caused by or results from the following:  Suicide, attempted suicide or any intentionally self-inflicted Injury, while sane or insane.  Any Sickness or declining process caused by a Sickness.  Participation or attempt to participate in a felony or illegal activity.  An Accident while the Covered Person is operating a motorized vehicle while intoxicated. Intoxication means the Covered Person’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the Accident occurred.  War or any act of war, whether declared or undeclared (excluding acts of terrorism).  Loss sustained while on active duty as a member of the armed forces of any nation. We will refund, upon Written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.  Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a Doctor.  Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.  Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded.  Engaging in hang-gliding, bungee jumping, parachuting, sailgliding, parasailing, parakiting, kitesurfing or any similar activities.  Practicing for, or participating in, any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received.  Work for pay, profit or gain.

RL-ACC3-ADR2-23-IN 5 ADR-12967 (11/25) PHYSICAL EXAMINATION We may require the Covered Person to be examined by one or more Doctors or other medical practitioners of our choice. We will pay for this examination. We can require an examination as often as it is reasonable to do so while the claim is pending. We may also require you or your Spouse to be interviewed by our authorized representative. Failure to comply with this request may result in denial or termination of benefits. AUTOPSY We may require an autopsy in case of death, at our expense, where it is not prohibited by law. BENEFIT PAYMENTS Benefits under this rider are payable to you unless otherwise specified. Once a claim has been approved, we will make payment immediately upon receipt of due Written proof of claim. Any accrued benefits that are payable at your death will be paid according to the BENEFIT PAYMENTS provision in the Certificate. For PORTABILITY FOLLOWING DEATH OR DIVORCE, benefits are payable to your Spouse, and any accrued benefits that are payable at the time of your Spouse’s death will be paid to your Spouse’s estate. Any payment we make in good faith will discharge our liability as to the extent of such payment. We will pay the benefits in one sum or in a method comparable to one sum. Executed at our home office: 250 Marquette Avenue Suite 900 Minneapolis, MN 55401 LEGAL ACTION A claimant can start legal action regarding a claim no earlier than 60 days after Written proof of claim has been given to us, and no later than three years from the time proof of claim is required, unless otherwise provided under federal law. Nothing in this provision waives, extends or tolls any applicable statute of limitations governing any claim relating in any way to the coverage. Amelia (Amy) J. Vaillancourt Melissa A. O'Donnell President Secretary