RL-CI4-SPR2-20-IN 2 SPR-12969 (11/25) SPOUSE CRITICAL ILLNESS BENEFITS Base module Covered illness/condition Percent of BENEFIT AMOUNT payable Total maximum benefit amount for coverage Heart Attack 100% No maximum benefit amount Cancer 100% No maximum benefit amount Stroke 100% No maximum benefit amount Sudden Cardiac Arrest 100% No maximum benefit amount Major Organ Transplant 100% No maximum benefit amount Coronary Artery Bypass 25% No maximum benefit amount Carcinoma in Situ (CIS) 25% No maximum benefit amount Major organ module Covered illness/condition Percent of BENEFIT AMOUNT payable Total maximum benefit amount for coverage Type 1 Diabetes 100% 1 times the BENEFIT AMOUNT Severe Burns 100% No maximum benefit amount Transient Ischemic Attacks (TIA) 10% No maximum benefit amount Ruptured or Dissecting Aneurysm 10% No maximum benefit amount Abdominal Aortic Aneurysm 10% No maximum benefit amount Thoracic Aortic Aneurysm 10% No maximum benefit amount Open Heart Surgery for Valve Replacement or Repair 25% No maximum benefit amount Transcatheter Heart Valve Replacement or Repair 10% No maximum benefit amount Coronary Angioplasty 10% No maximum benefit amount Implantable (or Internal) Cardioverter Defibrillator (ICD) Placement 25% No maximum benefit amount Pacemaker Placement 10% No maximum benefit amount
Critical Illness Insurance Plan for Noblesville Schools Employees Page 23 Page 25