3 SCHEDULE OF BENEFITS Employer(s): Jay School Corporation Plan Number: 6821 Original Plan Effective Date: July 1, 2009 Benefits Revised Date: May 1, 2023 Eligible Class: Class 01: Administrators and Certified Employees Employer Premium Contribution: All but $1.00 per Employee per year Elimination Period: 180 consecutive calendar days Minimum Hourly Work Requirement: 17.5 hours per week Waiting Period: None Evidence of Insurability: Required for Late Enrollees, Increases and amounts exceeding the Guarantee Issue Employee Eligibility Date: First of month following or coinciding with completion of the Waiting Period Minimum Participation Requirement: 90% Leaves and Sabbaticals: Coverage with premium payment while on FMLA leave; Coverage with premium payment for up to 12 months while on Paid or Unpaid Leave Definition of Disability: Partial Own Occupation Period: 60 months following the end of the Elimination Period Any Occupation Period: From the end of the Own Occupation Period to the end of the Maximum Benefit Period Cumulative Elimination Period: 15 Working Days Recurrent Disability: 3 months Predisability Earnings: Base pay only Maximum Monthly Covered Salary: $13,333 LTD Benefit Percentage: 66 2/3%