CRITICAL ILLNESS BENEFITS Pays once per covered person for each critical illness shown below. Benefit Percentage Recurrent Diagnosis Benefit Heart Attack Benefit Pays full lump sum benefit amount. 100% 50% Coronary Artery Bypass Surgery Pays 25% of benefit amount. Payment will reduce the Heart Attack benefit. 25% - Stroke Benefit (Permanent damage due to a stroke) Pays full lump sum benefit amount. 100% 50% Paralysis Benefit (Permanent due to a covered accident) Pays full lump sum benefit amount. 100% - Major Organ Failure Benefit Pays full lump sum benefit amount. 100% 50% End Stage Renal Failure Benefit Pays full lump sum benefit amount. 100% - SPOUSE MONTHLY RATES** $5,000 $10,000 $15,000 AGE Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco 18-29 $2.40 $4.18 $3.30 $6.86 $4.20 $9.54 30-39 $3.76 $6.58 $6.02 $11.66 $8.28 $16.74 40-49 $6.84 $11.96 $12.18 $22.42 $17.52 $32.88 50-59 $11.30 $19.74 $21.10 $37.98 $30.90 $56.22 60-69 $18.50 $32.32 $35.50 $63.14 $52.50 $93.96 EMPLOYEE MONTHLY RATES** $10,000 $20,000 $30,000 AGE Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco 18-29 $3.98 $6.30 $6.46 $11.10 $8.94 $15.90 30-39 $6.26 $9.90 $11.02 $18.30 $15.78 $26.70 40-49 $11.38 $17.98 $21.26 $34.46 $31.14 $50.94 50-59 $18.74 $29.66 $35.98 $57.82 $53.22 $85.98 60 & Over $30.66 $48.58 $59.82 $95.66 $88.98 $142.74 Schedule of Benefits Depending on the plan selected by your employer, the following benefit amounts may be available. The employee benefit amounts can range from $10,000, $20,000 or $30,000. Eligible children will be automatically covered at 25% of the employee's benefit amount at no additional cost.* If elected, spousal benefit amounts will be 50% of the employee benefit amount. Group Critical Illness Insurance **The premium and amount of benefits vary dependent upon the amount selected at time of application.