ICC18 LC14GP-2 3 D12995 (11/25) ELIGIBLE CLASS(ES) All Other Full-Time Certified or Central Office Classified Staff Employees not covered in Class 1 in Active Employment with the Employer in the United States. All Eligible Retirees who are receiving retirement benefits under an eligible retirement plan sponsored by the Employer. You must be an Employee of the Employer and in an eligible class. Temporary and seasonal workers are excluded from coverage. MINIMUM HOURS REQUIREMENT All Eligible Employees: 30 hours per week. Retirees: None ELIGIBILITY WAITING PERIOD Persons in an eligible class on or before the Policy effective date: End of month in which You begin Active Employment Persons entering an eligible class after the Policy effective date: End of month in which You begin Active Employment All Eligible Retirees: None 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. BASIC LIFE INSURANCE Basic life insurance is Noncontributory by Employees. Eligible Class(es) Amount All Eligible Employees $50,000 MAXIMUM AMOUNT OF BASIC LIFE INSURANCE $50,000 SCHEDULE OF BENEFITS EMPLOYER(S): Noblesville Schools GROUP POLICY NUMBER: 73058-1GAT2 Refer to the attached “Schedule of Benefits” document(s).