SCHEDULE OF BENEFITS NAME OF SUBSIDIARIES, DIVISIONS OR AFFILIATES TO BE COVERED: NONE 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 an Eligible Person completes his/her enrollment form. INDIVIDUAL REINSTATEMENT: 6 months MINIMUM PARTICIPATION REQUIREMENTS: Number of Insureds: 10 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. The Insured must be Actively at Work on the effective date of the change. If the Insured is not Actively at Work when the change would otherwise take effect, the change will take effect on the day after the Insured has 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: Each Eligible Person: 100% Each Eligible Person and Dependent spouse: 100% Each Eligible Person and Dependent child(ren): 100% Each Eligible Person and Dependents: 100% Receipt of benefits under this Policy may be taxable. It is recommended that the Insured contact his/her personal tax advisor. LRS-9547-0318-IN Page 1.0