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: Participation Percentage: 10% Number of Insured Persons: 10 AMOUNT OF INSURANCE: Eligible Person: Increments of $10,000 from a minimum of $10,000 to a maximum of $30,000. Dependent Coverage: Spouse: Increments of $10,000 from a minimum of $10,000 to a maximum of $30,000 not to exceed 100% of the Insured Person's approved Amount of Insurance. Child: 50% of the Insured Person's approved Amount of Insurance, up to $15,000. Child coverage is guaranteed issue and is not subject to proof of good health. LRS-9537-1-0118 Page 1.0