SCHEDULE OF BENEFITS NAME OF SUBSIDIARIES, DIVISIONS OR AFFILIATES TO BE COVERED: None ELIGIBLE CLASSES: Each active, Full-time employee, except any person employed on a temporary or seasonal basis, according to the following classifications: CLASS 1: Superintendent CLASS 2: Assistant Superintendent and Executive Director CLASS 3: Principal, Secondary Assistant Principal, Administrator and Athletic Director CLASS 4: Certified Personnel, Director, and Board Member CLASS 5: Non-Certified Personnel CLASS 6: Employee, except an employee included in any other class INDIVIDUAL EFFECTIVE DATE: The first of the month following the day the person becomes eligible. INDIVIDUAL REINSTATEMENT: 6 months MINIMUM PARTICIPATION REQUIREMENTS: Number of Insureds: 10 Percentage: Basic: 100% Supplemental: 25% AMOUNT OF INSURANCE: Basic Life and Accidental Death and Dismemberment: CLASS 1: Three (3) times Earnings, rounded to the next higher $1,000, subject to a maximum Amount of Insurance of $150,000. CLASS 2: Two and one half (2 1/2) times Earnings, rounded to the next higher $1,000, subject to a maximum Amount of Insurance of $100,000. CLASS 3: Two (2) times Earnings, rounded to the next higher $1,000, subject to a maximum Amount of Insurance of $100,000. CLASS 4: $50,000. CLASS 5: $25,000. Supplemental Life (Applicable only to those Insureds who elect Supplemental coverage and are paying the applicable premium): CLASS 1, 2, 3, 4, 5 & 6: $10,000 to $500,000 in increments of $10,000, not to exceed five (5) times Earnings. For any class with a combined Basic and Supplemental amount of $150,000 or more, the above Basic and Supplemental amounts cannot exceed a combined maximum of seven (7) times Earnings. Amounts of supplemental insurance over the guaranteed issue amount of $200,000 are subject to our approval of a person's proof of good health. However, any proof of good health required due to late application for this insurance (See EFFECTIVE DATE OF INDIVIDUAL INSURANCE) will be at no expense to us. LRS-6422-2 Ed. 04/16 Page 1.0