Voluntary Critical Illness Highlight Sheet

Plan Highlights Voluntary Group Critical Illness Insurance Goshen Community Schools COVERAGE Voluntary critical illness insurance provides a fixed, lump- sum benefit GUARANTEED ISSUE upon diagnosis of a critical illness, which can include heart attack, Employee: $30,000 Spouse: $30,000 stroke, paralysis and more. These benefits are paid directly to the insured and may be used for any reason, from deductibles and Child(ren): $15,000 prescriptions to transportation and child care. BENEFIT REDUCTION DUE TO AGE ELIGIBILITY Age Original Benefit Reduced to Each Active Full-Time Employee working 15 hours or more per 70 50% week, except for any person working on a temporary or seasonal basis. CONTRIBUTION REQUIREMENTS Dependents: You must be insured for your Dependents to be Coverage is 100% Employee Paid. covered. Dependents are:  Your legal spouse or your domestic partner. Spouse must be RATES under age 70 at date of application. Coverage terminates at See attached Rate Sheet age 75.  Your dependent children from birth to 26 years.  A person may not have coverage as both an Employee and Dependent. BENEFIT AMOUNT Employee: Choose from a benefit of $10,000 to a maximum of $30,000 in $10,000 increments. Spouse: Choose from a benefit of $10,000 to a maximum of $30,000 in $10,000 increments, not to exceed 100% of approved employee amount. Child(ren): 50% of approved employee amount up to a maximum of $15,000. www.reliancestandard.com This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-9537, et al. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state.

FEATURES  Lifetime Maximum Benefit – 1000% of Insurance Amount DIAGNOSIS ADULT BENEFIT  Subsequent Occurrence Benefit – 100% of benefit if diagnosed 3 Alzheimer’s Disease 50% months or later Benign Brain Tumor 75%  Recurrence Benefit (Same Illness) – 50% of benefit if diagnosed 12 Carcinoma In Situ 30% months or later Coma 100%  Transfer of Coverage  Portability to employee age 70 Coronary Disease 30%  Wellness (Health Screening) Benefit – $50 Heart Attack 100% Life Threatening Cancer 100% Loss of Hearing 100% Loss of Sight 100% Loss of Speech 100% Major Organ Failure 100% Motor Neuron Disease (ALS) 100% Multiple Sclerosis 30% Paralysis 100% Parkinson’s Disease 100% Ruptured Cerebral, Carotid or Aortic 25% Aneurysm Severe Brain Damage 25% Skin Cancer 5% Stroke 100% DIAGNOSIS CHILD BENEFIT Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Downs' Syndrome 100% Muscular Dystrophy 100% Spina Bifida 100% Type 1 Diabetes 100% www.reliancestandard.com This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-9537, et al. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state.