ICC18 LR14GP-ADD-2 1 ADD-12995 (11/25) This rider is made a part of the Group Term Life 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. BASIC EMPLOYEE AD&D INSURANCE Basic Employee AD&D insurance is Noncontributory by Employees. Eligible Class(es) Full Amount All Eligible Employees Equal to the amount of Basic Employee life insurance MAXIMUM AMOUNT OF BASIC EMPLOYEE AD&D INSURANCE $50,000 The Basic Employee AD&D insurance amount will not exceed the Basic Employee life insurance amount in force. SUPPLEMENTAL EMPLOYEE AD&D INSURANCE Supplemental Employee AD&D insurance is Contributory by Employees. Eligible Class(es) Full Amount All Eligible Employees Equal to the amount of Supplemental Employee life insurance MAXIMUM AMOUNT OF SUPPLEMENTAL EMPLOYEE AD&D INSURANCE $500,000 not to exceed 5 times your Basic Yearly Earnings ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) RIDER RELIASTAR LIFE INSURANCE COMPANY 250 Marquette Avenue, Suite 900, Minneapolis, Minnesota 55401 POLICYHOLDER: Noblesville Schools GROUP POLICY NUMBER: 73058-1GAT2 CONTENTS Schedule of Benefits................................................ page 1 Definitions................................................................ page 4 General Provisions................................................... page 5 AD&D Benefits......................................................... page 7 Exclusions................................................................ page 11 SCHEDULE OF BENEFITS