Group Vision Insurance Certificate

F I D E L I T Y S E C U R I T Y L I F E ® I N S U R A N C E C O M P A N Y 3130 Broadway Kansas City, Missouri 64111-2406 Phone 800-648-8624 A STOCK COMPANY (Herein Called “the Company”) POLICY NUMBER: VC-146 POLICYHOLDER: Jay School Corporation POLICY EFFECTIVE DATE: September 1, 2022 POLICY ANNIVERSARY DATE: September 1 of the following year and each September 1 thereafter Fidelity Security Life Insurance Company represents that the Insured Person is insured for the benefits described in the following pages, subject to and in accordance with the terms and conditions of the Policy. The Policy may be amended, changed, cancelled or discontinued without the consent of any Insured Person. The Certificate explains the plan of insurance. An individual identification card will be issued to the Insured containing the group name, group number, and Insured’s effective date. The Certificate replaces all certificates previously issued to the Insured under the Policy. All periods of time under the Policy will begin and end at 12:01 A.M. Local Time at the Policyholder’s business address. The Policy is issued by Fidelity Security Life Insurance Company at Kansas City, Missouri on the Policy Effective Date. FIDELITY SECURITY LIFE INSURANCE COMPANY President Secretary GROUP VISION INSURANCE CERTIFICATE THIS IS A LIMITED BENEFIT CERTIFICATE Please read the Certificate carefully. THIS PLAN IS NOT MEDICARE SUPPLEMENT. If you are eligible for Medicare, please review “Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare,” available from the Company. C-9184IN Exam/Materials