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