ICC19 RL-STD-CERT-19 13 D12972 (11/25) DISABILITY BENEFITS We will pay a benefit as shown on the SCHEDULE OF BENEFITS if you become Disabled and qualify to receive benefits. The benefit payable is based on the SCHEDULE OF BENEFITS in effect on the day you become Disabled. ELIMINATION PERIOD You must be continuously Disabled through your elimination period. Your elimination period is as stated in the SCHEDULE OF BENEFITS and is the period of continuous Disability you must satisfy before you are eligible to receive benefits under the Policy. We will consider your Disability to be continuous if your Disability stops during the elimination period for 5 days or less. The days that you are not Disabled will not count toward your elimination period. 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. SATISFYING YOUR ELIMINATION PERIOD IF YOU ARE WORKING If you are working while you are Disabled, the days you are Disabled will count toward your elimination period. WHEN YOU RECEIVE PAYMENTS You will begin to receive payments when we approve your claim, provided the elimination period has been met and you are Disabled. We will send you a Weekly Payment at the end of each week for any period for which we are liable. After the elimination period, if you are Disabled for less than one week, we will send you 1/7th of your Weekly Payment for each day of your Disability. AMOUNT OF PAYMENT A. IF YOU ARE TOTALLY DISABLED OR YOU ARE PARTIALLY DISABLED AND YOUR DISABILITY EARNINGS ARE LESS THAN 20% OF YOUR WEEKLY EARNINGS We will follow this process to figure your payment: 1. Multiply your Weekly Earnings by 67%. 2. The Maximum Benefit as shown in the SCHEDULE OF BENEFITS. 3. Compare the answers from Step 1 and Step 2. The lesser of these two amounts is your Gross Weekly Payment. 4. Subtract from your Gross Weekly Payment any Deductible Sources of Income. The amount figured in Step 4 is your Weekly Payment. If this amount is less than the Minimum Payment amount under the Policy, your payment will be subject to the MINIMUM PAYMENT provision. Your Weekly Payment will be the weekly benefit amount for which Premium is being paid. B. IF YOU ARE PARTIALLY DISABLED AND YOUR DISABILITY EARNINGS ARE AT LEAST 20% BUT LESS THAN OR EQUAL TO 80% OF YOUR WEEKLY EARNINGS You will receive payments based on the percentage of income you are losing due to your Disability. We will follow this process to determine your Weekly Payment: 1. Subtract your Disability Earnings from your Weekly Earnings. 2. Divide the answer in Step 1 by your Weekly Earnings. The result is your percentage of lost earnings. 3. From your Gross Weekly Payment, subtract any Deductible Sources of Income. 4. Multiply the answer in Step 2 by the answer in Step 3. The answer in Step 4 is your Weekly Payment. If this amount is less than the Minimum Payment amount under the Policy, your payment will be subject to the MINIMUM PAYMENT provision.

Short Term Disability Income Insurance Plan for Noblesville Schools - Page 14 Short Term Disability Income Insurance Plan for Noblesville Schools Page 13 Page 15