SCHEDULE OF BENEFITS This Certificate is intended to be read in its entirety. In order to understand all the conditions, exclusions and limitations applicable to its benefits, please read all the provisions carefully. The Schedule of Benefits provides a brief outline of your coverage and benefits. Please read the Description of Coverages and Benefits Section for full details. Subscriber: Elkhart Community Schools Effective Date of Subscriber Participation: June 1, 2016 Certificate Effective Date: June 1, 2024 Covered Class: Class 3 - All active Employees of the Employer classified as Custodian, regularly working a minimum of 30 hours per week in the United States, who are citizens or permanent resident aliens of the United States. SCHEDULE OF BENEFITS This Schedule of Benefits shows maximums, benefit periods and any limitations applicable to benefits provided for each Covered Person unless otherwise indicated. Principal Sum, when referred to in this Schedule, means the Employee’s Principal Sum in effect on the date of the Covered Accident causing the Covered Injury or Covered Loss unless otherwise specified. Eligibility Waiting Period The Eligibility Waiting Period is the period of time the Employee must be in a Covered Class to be eligible for coverage. For Employees hired on or before the Policy Effective Date: The first of the month following 56 days of Active Service For Employees hired after the Policy Effective Date: The first of the month following 56 days of Active Service Time Period for Loss: Any Covered Loss must occur within: 365 days of the Covered Accident Maximum Age for Insurance: None BASIC ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS Employee Principal Sum: $35,000 1
Group AD&D Certificate Class 3 Page 10 Page 12