SCHEDULE OF BENEFITS EFFECTIVE DATE: January 1, 2023 ELIGIBLE CLASSES: Each Active Full-time employee, except any person employed on a temporary or seasonal basis. INDIVIDUAL EFFECTIVE DATE: The first day of the month following the date you complete your enrollment form. INDIVIDUAL REINSTATEMENT: 6 months COVERAGE TYPE: On and off-the-Job (24 hour) coverage CHANGES IN BENEFIT AMOUNTS: Increases in the Benefit Amounts due to a change in age are effective on the January 1st coinciding with or next following the date of the change. Increases in the Benefit Amounts due to a change in class are effective on the date of the change. You must be Actively at Work on the effective date of the change. If you are not Actively at Work when the change would otherwise take effect, the change will take effect on the day after you have returned to Active Work in an Eligible Class for one full day. Decreases in the Benefit Amounts due to a change in age are effective on the January 1st coinciding with or next following the date of the change. Decreases in the Benefit Amounts due to a change in class are effective on the date of the change. CONTRIBUTIONS: You are required to contribute toward the cost of your insurance coverage. You are required to contribute toward the cost of the Dependent Insurance coverage. Receipt of benefits under the Policy may be taxable. It is recommended that you contact your personal tax advisor. LRS-9548-0318-IN Page 1.0