STDisability IN

Disability Income Insurance Focus on Recovery, Not Expenses How would you cover your everyday expenses if you experienced an Injury or Sickness and couldn’t work for a period of time? AF™ Short-Term Disability Income Insurance provides a steady benefit to cover everyday expenses while you are unable to work due to a covered Disability. Plan Highlights Benefits are Payable Directly to You You have the freedom to use the funds for your daily expenses such as: groceries, mortgage, daycare, etc. Customized to Meet Your Individual Needs AF™ Short-Term You can select a benefit amount and elimination period that best meets Disability Income your financial needs. Insurance Return-to-Work Benefit Indiana Schools Employees may receive a partial benefit for going back to work part- time while still on Disability. Choose the Right Plan for You BENEFITS BEGIN on the day of Disability due to a covered Injury or Sickness. Plan I & II On the 31st day Injury means physical harm or damage to the body you sustained which results directly from an accidental bodily Injury and is independent of disease or bodily infirmity. Sickness means a disease or illness (including pregnancy). Disability must begin while your coverage is active. Hospital - the term “Hospital” shall not include an institution used by you as a place for rehabilitation; a place for rest or for the aged; a nursing or convalescent home; a long-term nursing unit or geriatrics ward; or an extended care facility for the care of convalescent, rehabilitative, or ambulatory patients. Disability or disabled means that you are unable to perform the material and substantial duties of your regular occupation. EMPLOYER BENEFIT SOLUTIONS FOR YOUR INDUSTRY

Benefit Policy Schedule Several benefit options are available to you. You may participate in the plan under any one of the benefit levels outlined below, provided the Monthly 2/3 Disability Benefit level selected does not exceed 66 % of your monthly compensation. Plan I Premiums Per Pay Period Monthly Monthly Salary Disability 26 Pay 24 Pay 22 Pay 21 Pay 20 Pay 19 Pay 18 Pay 17 Pay Monthly Benefit $300.00 - $449.99 $200.00 $1.30 $1.40 $1.53 $1.60 $1.68 $1.77 $1.87 $1.98 $2.80 $450.00 - $599.99 $300.00 $1.94 $2.10 $2.29 $2.40 $2.52 $2.66 $2.80 $2.96 $4.20 $600.00 - $749.99 $400.00 $2.58 $2.80 $3.06 $3.20 $3.36 $3.54 $3.74 $3.95 $5.60 $750.00 - $899.99 $500.00 $3.24 $3.50 $3.82 $4.00 $4.20 $4.42 $4.67 $4.94 $7.00 $900.00 - $1,049.99 $600.00 $3.88 $4.20 $4.58 $4.80 $5.04 $5.31 $5.60 $5.93 $8.40 $1,050.00 - $1,199.99 $700.00 $4.52 $4.90 $5.35 $5.60 $5.88 $6.19 $6.54 $6.92 $9.80 $1,200.00 - $1,349.99 $800.00 $5.18 $5.60 $6.11 $6.40 $6.72 $7.08 $7.47 $7.91 $11.20 $1,350.00 - $1,499.99 $900.00 $5.82 $6.30 $6.88 $7.20 $7.56 $7.96 $8.40 $8.89 $12.60 $1,500.00 - $1,649.99 $1,000.00 $6.46 $7.00 $7.64 $8.00 $8.40 $8.84 $9.34 $9.88 $14.00 $1,650.00 - $1,799.99 $1,100.00 $7.12 $7.70 $8.40 $8.80 $9.24 $9.73 $10.27 $10.87 $15.40 $1,800.00 - $1,949.99 $1,200.00 $7.76 $8.40 $9.17 $9.60 $10.08 $10.61 $11.20 $11.86 $16.80 $1,950.00 - $2,099.99 $1,300.00 $8.40 $9.10 $9.93 $10.40 $10.92 $11.50 $12.14 $12.85 $18.20 $2,100.00 - $2,249.99 $1,400.00 $9.06 $9.80 $10.69 $11.20 $11.76 $12.38 $13.07 $13.84 $19.60 $2,250.00 - $2,399.99 $1,500.00 $9.70 $10.50 $11.46 $12.00 $12.60 $13.27 $14.00 $14.82 $21.00 $2,400.00 - $2,549.99 $1,600.00 $10.34 $11.20 $12.22 $12.80 $13.44 $14.15 $14.94 $15.81 $22.40 $2,550.00 - $2,699.99 $1,700.00 $10.98 $11.90 $12.98 $13.60 $14.28 $15.03 $15.87 $16.80 $23.80 $2,700.00 - $2,849.99 $1,800.00 $11.64 $12.60 $13.75 $14.40 $15.12 $15.92 $16.80 $17.79 $25.20 $2,850.00 - $2,999.99 $1,900.00 $12.28 $13.30 $14.51 $15.20 $15.96 $16.80 $17.74 $18.78 $26.60 $3,000.00 - $3,149.99 $2,000.00 $12.92 $14.00 $15.28 $16.00 $16.80 $17.69 $18.67 $19.76 $28.00 $3,150.00 - $3,299.99 $2,100.00 $13.58 $14.70 $16.04 $16.80 $17.64 $18.57 $19.60 $20.75 $29.40 $3,300.00 - $3,449.99 $2,200.00 $14.22 $15.40 $16.80 $17.60 $18.48 $19.46 $20.54 $21.74 $30.80 $3,450.00 - $3,599.99 $2,300.00 $14.86 $16.10 $17.57 $18.40 $19.32 $20.34 $21.47 $22.73 $32.20 $3,600.00 - $3,749.99 $2,400.00 $15.52 $16.80 $18.33 $19.20 $20.16 $21.22 $22.40 $23.72 $33.60 $3,750.00 - $3,899.99 $2,500.00 $16.16 $17.50 $19.09 $20.00 $21.00 $22.11 $23.34 $24.71 $35.00 $3,900.00 - $4,049.99 $2,600.00 $16.80 $18.20 $19.86 $20.80 $21.84 $22.99 $24.27 $25.69 $36.40 $4,050.00 - $4,199.99 $2,700.00 $17.46 $18.90 $20.62 $21.60 $22.68 $23.88 $25.20 $26.68 $37.80 $4,200.00 - $4,349.99 $2,800.00 $18.10 $19.60 $21.38 $22.40 $23.52 $24.76 $26.14 $27.67 $39.20 $4,350.00 - $4,499.99 $2,900.00 $18.74 $20.30 $22.15 $23.20 $24.36 $25.64 $27.07 $28.66 $40.60 $4,500.00 - $4,649.99 $3,000.00 $19.38 $21.00 $22.91 $24.00 $25.20 $26.53 $28.00 $29.65 $42.00 $4,650.00 - $4,799.99 $3,100.00 $20.04 $21.70 $23.68 $24.80 $26.04 $27.41 $28.94 $30.64 $43.40 $4,800.00 - $4,949.99 $3,200.00 $20.68 $22.40 $24.44 $25.60 $26.88 $28.30 $29.87 $31.62 $44.80 $4,950.00 - $5,099.99 $3,300.00 $21.32 $23.10 $25.20 $26.40 $27.72 $29.18 $30.80 $32.61 $46.20 $5,100.00 - $5,249.99 $3,400.00 $21.98 $23.80 $25.97 $27.20 $28.56 $30.07 $31.74 $33.60 $47.60 $5,250.00 - $5,399.99 $3,500.00 $22.62 $24.50 $26.73 $28.00 $29.40 $30.95 $32.67 $34.59 $49.00 $5,400.00 - $5,549.99 $3,600.00 $23.26 $25.20 $27.49 $28.80 $30.24 $31.83 $33.60 $35.58 $50.40 $5,550.00 - $5,699.99 $3,700.00 $23.92 $25.90 $28.26 $29.60 $31.08 $32.72 $34.54 $36.56 $51.80 $5,700.00 - $5,849.99 $3,800.00 $24.56 $26.60 $29.02 $30.40 $31.92 $33.60 $35.47 $37.55 $53.20 $5,850.00 - $5,999.99 $3,900.00* $25.20 $27.30 $29.78 $31.20 $32.76 $34.49 $36.40 $38.54 $54.60 *Higher benefit amounts available, up to $7,500, based on your Monthly Salary.

Benefit Policy Schedule (continued) Several benefit options are available to you. You may participate in the plan under any one of the benefit levels outlined below, provided the Monthly Disability Benefit level selected does not exceed 662/3% of your monthly compensation. Plan II Premiums Per Pay Period Monthly Monthly Salary Disability 26 Pay 24 Pay 22 Pay 21 Pay 20 Pay 19 Pay 18 Pay 17 Pay Monthly Benefit $300.00 - $449.99 $200.00 $1.78 $1.92 $2.10 $2.20 $2.31 $2.43 $2.56 $2.71 $3.84 $450.00 - $599.99 $300.00 $2.66 $2.88 $3.14 $3.29 $3.46 $3.64 $3.84 $4.07 $5.76 $600.00 - $749.99 $400.00 $3.54 $3.84 $4.19 $4.39 $4.61 $4.85 $5.12 $5.42 $7.68 $750.00 - $899.99 $500.00 $4.44 $4.80 $5.24 $5.49 $5.76 $6.07 $6.40 $6.78 $9.60 $900.00 - $1,049.99 $600.00 $5.32 $5.76 $6.29 $6.59 $6.91 $7.28 $7.68 $8.13 $11.52 $1,050.00 - $1,199.99 $700.00 $6.20 $6.72 $7.33 $7.68 $8.07 $8.49 $8.96 $9.49 $13.44 $1,200.00 - $1,349.99 $800.00 $7.10 $7.68 $8.38 $8.78 $9.22 $9.70 $10.24 $10.84 $15.36 $1,350.00 - $1,499.99 $900.00 $7.98 $8.64 $9.43 $9.88 $10.37 $10.92 $11.52 $12.20 $17.28 $1,500.00 - $1,649.99 $1,000.00 $8.86 $9.60 $10.48 $10.97 $11.52 $12.13 $12.80 $13.55 $19.20 $1,650.00 - $1,799.99 $1,100.00 $9.76 $10.56 $11.52 $12.07 $12.67 $13.34 $14.08 $14.91 $21.12 $1,800.00 - $1,949.99 $1,200.00 $10.64 $11.52 $12.57 $13.17 $13.83 $14.55 $15.36 $16.26 $23.04 $1,950.00 - $2,099.99 $1,300.00 $11.52 $12.48 $13.62 $14.27 $14.98 $15.77 $16.64 $17.62 $24.96 $2,100.00 - $2,249.99 $1,400.00 $12.42 $13.44 $14.66 $15.36 $16.13 $16.98 $17.92 $18.97 $26.88 $2,250.00 - $2,399.99 $1,500.00 $13.30 $14.40 $15.71 $16.46 $17.28 $18.19 $19.20 $20.33 $28.80 $2,400.00 - $2,549.99 $1,600.00 $14.18 $15.36 $16.76 $17.56 $18.43 $19.40 $20.48 $21.68 $30.72 $2,550.00 - $2,699.99 $1,700.00 $15.06 $16.32 $17.81 $18.65 $19.59 $20.62 $21.76 $23.04 $32.64 $2,700.00 - $2,849.99 $1,800.00 $15.96 $17.28 $18.85 $19.75 $20.74 $21.83 $23.04 $24.40 $34.56 $2,850.00 - $2,999.99 $1,900.00 $16.84 $18.24 $19.90 $20.85 $21.89 $23.04 $24.32 $25.75 $36.48 $3,000.00 - $3,149.99 $2,000.00 $17.72 $19.20 $20.95 $21.95 $23.04 $24.26 $25.60 $27.11 $38.40 $3,150.00 - $3,299.99 $2,100.00 $18.62 $20.16 $22.00 $23.04 $24.19 $25.47 $26.88 $28.46 $40.32 $3,300.00 - $3,449.99 $2,200.00 $19.50 $21.12 $23.04 $24.14 $25.35 $26.68 $28.16 $29.82 $42.24 $3,450.00 - $3,599.99 $2,300.00 $20.38 $22.08 $24.09 $25.24 $26.50 $27.89 $29.44 $31.17 $44.16 $3,600.00 - $3,749.99 $2,400.00 $21.28 $23.04 $25.14 $26.33 $27.65 $29.11 $30.72 $32.53 $46.08 $3,750.00 - $3,899.99 $2,500.00 $22.16 $24.00 $26.18 $27.43 $28.80 $30.32 $32.00 $33.88 $48.00 $3,900.00 - $4,049.99 $2,600.00 $23.04 $24.96 $27.23 $28.53 $29.95 $31.53 $33.28 $35.24 $49.92 $4,050.00 - $4,199.99 $2,700.00 $23.94 $25.92 $28.28 $29.63 $31.11 $32.74 $34.56 $36.59 $51.84 $4,200.00 - $4,349.99 $2,800.00 $24.82 $26.88 $29.33 $30.72 $32.26 $33.96 $35.84 $37.95 $53.76 $4,350.00 - $4,499.99 $2,900.00 $25.70 $27.84 $30.37 $31.82 $33.41 $35.17 $37.12 $39.30 $55.68 $4,500.00 - $4,649.99 $3,000.00 $26.58 $28.80 $31.42 $32.92 $34.56 $36.38 $38.40 $40.66 $57.60 $4,650.00 - $4,799.99 $3,100.00 $27.48 $29.76 $32.47 $34.01 $35.71 $37.59 $39.68 $42.01 $59.52 $4,800.00 - $4,949.99 $3,200.00 $28.36 $30.72 $33.51 $35.11 $36.87 $38.81 $40.96 $43.37 $61.44 $4,950.00 - $5,099.99 $3,300.00 $29.24 $31.68 $34.56 $36.21 $38.02 $40.02 $42.24 $44.72 $63.36 $5,100.00 - $5,249.99 $3,400.00 $30.14 $32.64 $35.61 $37.31 $39.17 $41.23 $43.52 $46.08 $65.28 $5,250.00 - $5,399.99 $3,500.00 $31.02 $33.60 $36.66 $38.40 $40.32 $42.44 $44.80 $47.44 $67.20 $5,400.00 - $5,549.99 $3,600.00 $31.90 $34.56 $37.70 $39.50 $41.47 $43.66 $46.08 $48.79 $69.12 $5,550.00 - $5,699.99 $3,700.00 $32.80 $35.52 $38.75 $40.60 $42.63 $44.87 $47.36 $50.15 $71.04 $5,700.00 - $5,849.99 $3,800.00 $33.68 $36.48 $39.80 $41.69 $43.78 $46.08 $48.64 $51.50 $72.96 $5,850.00 - $5,999.99 $3,900.00* $34.56 $37.44 $40.85 $42.79 $44.93 $47.30 $49.92 $52.86 $74.88 *Higher benefit amounts available, up to $7,500, based on your Monthly Salary.

Plan Benefit Highlights Maximum Benefit Period Pre-Existing Condition Limitation Benefits are payable up to 90 (Plan I) or 150 (Plan II) days for a No disability benefit will be payable if Disability is caused by or covered Injury or Sickness. resulting from a Pre-Existing Condition and begins before you have been continuously covered under the policy for 12 months. This provision will not apply if you have: received no treatment When Coverage Begins and received no diagnosis or advice from a physician, for 12 Certificates will become effective on the requested effective date consecutive months for such condition(s). following the date we approve the application, provided you are on This limitation will not apply to a Disability resulting from a Pre- active employment and premium has been paid. Existing Condition that begins after you have been continuously Physician Expense Benefit covered under the policy for 12 months. Injury - $150.00 per Injury Any increase in benefits will be subject to this Pre-Existing If you need personal treatment by a physician due to an Injury, we Condition limitation. A new Pre-Existing Condition period must will pay the amount shown above provided no other claim has been be met with respect to any increase applied for and approved paid under the policy. You are not required to miss one full day by us. of work in order to receive the Injury benefit. This benefit will be Pre-Existing Condition means a disease, Injury, Sickness, physical limited to 8 payments per calendar year. condition or mental illness for which you: recieved treatment; or Accidental Death Benefit received a diagnosis or advice from a physician, during the 12 month period immediately before your effective date of coverage. A lump sum of $50,000 will be paid to your designated beneficiary if The term Pre-Existing Condition will also include conditions which you die as the direct result of an Injury within 90 days after are related to such disease, Injury, Sickness, physical condition, or the Injury. mental illness. Survivor Benefit A lump sum benefit equal to 3 times the Disability payment will be paid if on the date of your death your Disability had continued for 90 or more consecutive days and you were receiving or entitled to receive Disability payments. The Survivor Benefit may be paid earlier if you have a terminal illness. Donor Benefit If you are Disabled as a result of being an organ or tissue donor, we will pay your benefit as any other Sickness under the terms of the plan. If You Are Disabled Due to a Covered Disability and Not Working We will pay the disability Benefit described in the benefit schedule. No Disability payment will be provided for any period in which you are not under the regular and appropriate care of a physician.

Plan Benefit Highlights Policy Exclusions The term “entitled to Workers’ Compensation” shall also include The policy does not cover any loss, fatal or non-fatal, resulting from: Workers’ Compensation claim settlements that occur via compromise and release. Further, no benefits will be paid under • Intentionally self-inflicted Injury while sane or insane. this policy for any period during which you are entitled to • An act of war, declared or undeclared. Workers’ Compensation benefits. • Injury sustained or Sickness contracted while in the service Your coverage may be extended for up to 1 year during a leave of the armed forces of any country. of absence approved in writing by your employer. Coverage • Committing a felony. will continue as long as the group policy remains in force, the premiums are paid and you remain eligible for the coverage • Penal incarceration. We will not pay benefits for Disability under the policy. Your coverage will end when you no or any other loss during any period for which you are longer qualify as an insured, you retire, you are not on active incarcerated in a penal or correctional institution for a employment, or your employment terminates. Your coverage period of 30 consecutive days or longer. can be terminated or premiums may be increased on any • Injury or Sickness arising out of and in the course of any premium due date with 31 days advance notice. occupation for wage or profit or for which you are entitled to Workers’ Compensation.

Benefit Riders and Limitations Hospital Indemnity Limited Benefit Rider COBRA Funding Rider This rider is designed to pay a daily benefit amount for a Hospital (not available on plans with less than a 1 year Confinement, up to a maximum of 90 days, if you are confined to benefit period) a Hospital. This rider is designed to help cover the cost of COBRA premiums if you elect COBRA coverage while you are receiving Disability Benefits. Benefits are not payable for Injury or Sickness incurred in the first 12 months of coverage due to a Pre-Existing Condition In order to receive benefits under this rider, you must: be as defined in the base policy. Patient must be confined to a receiving benefits under your Disability base plan; elect medical Hospital for a minimum of 18 hours and charged room COBRA coverage; and be paying medical COBRA premiums. This and board. benefit will pay up to the end of the Disability benefit period Daily Benefit Monthly Premium or to the end of your medical COBRA benefit period, whichever occurs first. $100.00 $6.00 $150.00 $9.00 Monthly Benefit Amount Monthly Premium $300.00 $4.50 $400.00 $6.00 $500.00 $7.50 $600.00 $9.00 Critical Illness Benefit Rider This rider is designed to provide a lump sum benefit based on diagnosis of a certain Critical Illness. Benefits are payable at a one-time lump sum benefit amount based on diagnosis of the following conditions heart attack, stroke, kidney failure, paralysis, or major organ failure. In the case of heart attack, a physician must make the diagnosis and treatment must occur within 72 hours of the onset of symptoms. Benefit Amount Monthly Premium Spousal Accident Only Disability $10,000.00 $9.80 Benefit Rider $15,000.00 $13.18 This rider is designed to provide a monthly benefit if your Spouse $20,000.00 $16.56 suffers a Disability due to a non-occupational accident. $25,000.00 $19.94 Pays a monthly benefit amount to you for your Spouse who is Disabled as a result of a non-occupational accident. Benefits begin on the 31st consecutive day after the Injury and will continue for up to two years. Monthly Benefit Annual Salary Monthly Premium Amount $500.00 up to $10,000.00 $4.00 $1,000.00 $10,001.00 - $8.00 $20,000.00 $1,500.00 $20,001.00 - $12.00 $30,000.00 $2,000.00 $30,001.00 $16.00 and over

Benefit Rider Limitations and Exclusions Hospital Indemnity Limited Benefit Rider Spouse is incarcerated in a penal or correctional institution or The Hospital Confinement Benefit will not be payable for an Injury for any Injury that occurs while your Spouse is incarcerated in or Sickness incurred in the first 12 months of coverage if the Injury a penal or correctional institution; Injury arising out of and in or Sickness is caused by or resulting from a Pre-Existing Condition the course of any occupation for wage or profit or for which as defined in the policy. In addition to the exclusions listed in the your Spouse is entitled to Workers’ Compensation. The term policy, no benefits will be payable under this rider for any Hospital “entitled to Workers’ Compensation” shall also include Workers’ confinement that is caused by or resulting from mental illness Compensation claim settlements which occur via compromise or drug or alcohol abuse. Benefits are reduced by 50% at age 70. and release. Further, no benefits will be paid under this policy Successive Hospital stays will be considered as one confinement for any period during which your Spouse is entitled to Workers’ if they are separated by less than 90 days of confinement to a Compensation benefits; participation in any sport for wage or Hospital. profit; participation in any contest of speed in a power driven vehicle for wage or profit. The term “Hospital” shall not include an institution used by you as Spouse means the person you are lawfully married to who is a place for rehabilitation; a place for rest or for the aged; a nursing less than age 70. Your spouse must be engaged in Full-Time or convalescent home; a long-term nursing unit or geriatrics Employment for benefits to be payable. Full-Time Employment ward; or as an extended care facility for the care of convalescent, means your spouse is employed an average of 25 or more rehabilitative , or ambulatory patients. hours per week for pay or benefits. Full-Time Employment Critical Illness Benefit Rider does not include any hours your spouse is working while self- The Critical Illness Benefit rider will not be payable for any loss employed. No benefits are payable for your Spouse under this caused by or resulting from: a Critical Illness when the date rider for a Disability from an Injury that occurred outside of the of diagnosis occurs during the waiting period; a Critical Illness United States or its territories. No benefit will be provided for diagnosed outside of the United States; or a Sickness or Injury not any period in which your Spouse is not under the regular and specifically defined in this Rider. appropriate care of a physician. No benefits will be paid for any Injury to your Spouse which is caused by or resulting from No Critical Illness Benefit will be payable for a Critical Illness which Spousal abuse. is caused by or resulting from a Pre-Existing Condition when the Your coverage with respect to the riders listed above will end Critical Illness date of diagnosis occurs before you have been on the earliest of these dates: the end of the last period for continuously covered under this rider for 12 consecutive months. which premium has been paid; the date you notify us in writing Following 12 consecutive months this exclusion does not apply. to terminate coverage; the date the rider is discontinued; the Pre-Existing Condition means a disease, Injury, Sickness, physical date the policy is discontinued; or the date your employment condition or mental illness for which you have experienced any of terminates. the following: received treatment or received a diagnosis or advice Availability of riders may vary by state, employer and short- from a Physician, during the 12-month period immediately before term coverage with a benefit period of less than 12 months. the Effective Date of this Rider. The term Pre-Existing Condition Additional riders are subject to our general underwriting will also include conditions which are related to such disease, guidelines and coverage is not guaranteed. Riders have Injury, Sickness, physical condition or mental illness. Benefits limitations, exclusions, and waiting periods. Refer to your policy reduce by 50% at age 70. No benefits will be paid for a Critical for complete details. These riders will terminate on the same Illness when the date of diagnosis occurs during the Critical Illness date as the policy or certificate to which it is attached. waiting period. The waiting period is 30 days from the effective date of this rider. COBRA Funding Benefit Rider Proof of election of medical COBRA continuation must be provided to American Fidelity. Proof of continued medical COBRA participation will be required before benefits are paid under this rider. Your employment must have terminated for the benefit to be payable. Spousal Accident Only Disability Benefit Rider This rider does not provide benefits for your Spouse for any Disability, fatal or non-fatal, which results from any of the following: intentionally self-inflicted Injury while sane or insane; an act of war, declared or undeclared; Injury sustained or contracted while in the service of the armed forces of any country; committing a felony; penal incarceration. American Fidelity will not pay benefits during any period for which your

Disability Income Insurance Your benefits, all in one place. Manage your American Fidelity benefits and reimbursement accounts through your online account or the AFmobile® app. Policy provisions and benefits may vary if you reside in a state other than your employer’s state of domicile. Pre-Existing Conditions may apply. This brochure highlights important features of the policy. Please refer to your certificate for complete details. American Fidelity Assurance Company 800-662-1113 • americanfidelity.com G120-074 MCH# 3999, 8813 014268-6, 014286-7, SB-32431-0222 014709-R1, 014710-R1, 014708-R1