3 SCHEDULE OF BENEFITS A. Administrative 1. Employer: Jay School Corporation 2. Plan Number: 30051 3. Initial Plan Effective Date: June 1, 2013 4. Benefits Revised Date: January 1, 2024 5. Evidence of Insurability Requirements: Applies to Late Enrollees, Increases in Benefits and Amounts over Guarantee Issue Amounts 6. Eligible Class: 03 Bus Drivers 7. Minimum Hourly Work Requirement: 10 hours per week 8. Waiting Period for Insurance Coverage: None 9. New Employee Eligibility Date: First of month following or coinciding with completion of the Waiting Period 10. Leaves / Layoffs: Coverage with premium payment while on FMLA leave; Coverage with premium payment for up to 12 months while on Paid or Unpaid Leave 11. Employee Premium Contribution Employee Basic Insurance: The Employer pays all but $1.00 per Employee per year Employee Supplemental Insurance: 100% 12. Participation Requirements Employee Basic Insurance: 90% Employee Supplemental Insurance: 0% 13. Insurance Reduction Schedule Employee Basic Insurance: Basic Life and AD&D Insurance reduces to 65% upon the Insured Employee’s attainment of age 65, reduces to 50% upon the Insured Employee’s attainment of age 70 and terminates upon the Insured Employee’s retirement Employee Supplemental Insurance: Supplemental Life and AD&D Insurance reduces to 65% upon the Insured Employee’s attainment of age 65, reduces to 50% upon the Insured Employee’s attainment of age 70 and terminates upon the Insured Employee’s retirement B. Basic Life Insurance Employee Basic Life: $30,000 Guarantee Issue: $30,000 C. Supplemental Life Insurance Employee Supplemental Life: $10,000 Guarantee Issue: $10,000 D. Additional Benefits 1. Conversion of Insurance Benefit: Included 2. Waiver of Premium Benefit: Included 3. Accelerated (Living) Benefit: Included