ICC19 RL-STD-CERT-19 3 D12972 (11/25) 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 workers are excluded from coverage. Seasonal workers are excluded from coverage. MINIMUM HOURS REQUIREMENT 30 hours per week ELIGIBILITY WAITING PERIOD For persons in an eligible class on or before the Policy Effective Date: End of month in which You begin Active Employment. For persons entering an eligible class after the Policy Effective Date: End of month in which You begin Active Employment. 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 and Certificate provisions apply. WHO PAYS FOR THE COVERAGE You pay the cost of your coverage. ELIMINATION PERIOD 7 consecutive days. The elimination period begins on the first day of your Disability. Benefits for a Payable Claim begin the day after the elimination period is completed. MAXIMUM BENEFIT The Maximum Benefit is: $1,750 per week. WEEKLY BENEFIT 67% of Weekly Earnings to a Maximum Benefit of $1,750 per week. Your benefit may be reduced by any Deductible Sources of Income and Disability Earnings. Some Disabilities may not be covered or may have limited coverage under the Policy. SCHEDULE OF BENEFITS EMPLOYER: Noblesville Schools GROUP POLICY NUMBER: 73058-1STD2