AMERICAN HERITAGE LIFE INSURANCE COMPANY 1776 American Heritage Life Drive, Jacksonville, Florida 32224-6687 ACCELERATED DEATH BENEFIT FOR LONG TERM CARE WITH EXTENSION OF BENEFITS RIDER TAX QUALIFICATION NOTICE: This rider is intended to provide a qualified accelerated death benefit that is excluded from gross income for federal income tax purposes under the applicable provisions of the Internal Revenue Code in existence at the time this rider is issued. To that end, the provisions of this rider and the policy are to be interpreted to ensure or maintain such tax qualification, notwithstanding any other provision to the contrary. We reserve the right to amend this rider or the policy to reflect any clarifications that may be needed or are appropriate to maintain such tax qualification or to conform this rider or the policy to any applicable changes in such tax qualification requirements. We will send the certificate holder a copy of any such amendment. If the certificate holder refuses such an amendment, it must be by giving us written notice, and the certificate holder’s refusal may result in adverse tax consequences. Whether any tax liability may be incurred when benefits are paid under this rider could depend on whether the certificate holder is also the insured and how the Internal Revenue Service interprets applicable provisions of the Internal Revenue Code. As with any tax matter, the certificate holder and any other recipient of this benefit should each consult his or her own tax advisor to evaluate any tax impact of this benefit. Receipt of an accelerated death benefit MAY AFFECT MEDICAID and SUPPLEMENTAL SECURITY INCOME (“SSI”) eligibility. Without exercising this option, the mere fact that this Accelerated Death Benefit for Long Term Care with Extension of Benefits Rider is part of the policy will not in and of itself affect the eligibility for these government programs. However, exercising this option before the certificate holder applies for these programs, or when he or she is receiving government benefits, may affect his or her continued eligibility. Contact the Medicaid Unit of the local Department of Public Welfare and Social Security Administration Office for more information. This rider is issued in consideration of the rider premium and the written request for this rider. This rider is a part of the policy and is effective as of the rider effective date. Every definition, term, condition, and provision of the policy applies to this rider, unless otherwise defined or provided in this rider. This rider does not have a cash value or loan value. THIS RIDER DOES NOT QUALIFY FOR MEDICAID ASSET PROTECTION UNDER THE INDIANA LONG TERM CARE PROGRAM. HOWEVER, THIS RIDER IS AN APPROVED ACCELERATED DEATH BENEFIT FOR LONG TERM CARE RIDER UNDER STATE INSURANCE REGULATIONS. FOR INFORMATION ABOUT POLICIES AND CERTIFICATES QUALIFYING UNDER THE INDIANA LONG TERM CARE PROGRAM, CALL THE SENIOR HEALTH INSURANCE INFORMATION PROGRAM OF THE DEPARTMENT OF INSURANCE AT 1-800-452-4800. DEFINITIONS Activities of daily living (ADLs) mean activities used to measure the insured’s impairment due to being chronically ill. ADLs are any of the following: 1. Bathing – washing oneself by sponge bath; or in either a tub or shower, including the act of getting into and out of the tub or shower, with or without the aid of equipment. 2. Continence – the ability to maintain control of bowel and bladder function; or when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag), with or without the aid of equipment. 3. Dressing – putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs. 4. Eating – feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table) or by a feeding tube or intravenously. 5. Toileting – getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene. 6. Transferring – the ability to move into or out of a bed, chair or wheelchair. Adult day care means a program for 6 or more individuals, of social and health-related services provided during the day in a community group setting for the purpose of supporting persons who are chronically ill and can benefit from care in a group setting outside the home. Adult day care center means a facility or part of a facility that provides adult day care and is appropriately licensed or certified to provide such services (if required by the jurisdiction in which it is operating). GWPLTCE1IN Page 1