SCHEDULE OF BENEFITS NAME OF SUBSIDIARIES, DIVISIONS OR AFFILIATES TO BE COVERED: NONE ELIGIBLE CLASSES: Each active, Full-time Employee earning an annual salary of at least $15,000, except any person employed on a temporary or seasonal basis. INDIVIDUAL EFFECTIVE DATE: The first of the month following the date an Eligible Person completes his/her enrollment form. INDIVIDUAL REINSTATEMENT: 6 months MINIMUM PARTICIPATION REQUIREMENTS: Percentage: 25% Number of Insureds: 10 WEEKLY INCOME BENEFIT DAY BENEFITS BEGIN: Benefits, for one period of disability, will be paid as follows: INJURY AND SICKNESS: We will pay benefits from the fifteenth consecutive day of disability. MAXIMUM BENEFIT PERIOD: Benefits, for one period of disability, will be paid up to a maximum of eleven (11) weeks. WEEKLY INCOME BENEFIT: Each Eligible Person may elect an amount of insurance in increments of $25 from a minimum of $100 to a maximum of $1,500 per week up to 60% of his/her Earnings (rounded to the next lower increment), payable in accordance with the section entitled Weekly Income Insurance. The daily benefit payable for periods of disability of less than a full week will be 1/7th of the weekly benefit. MINIMUM WEEKLY BENEFIT: In no event will the Weekly Income Benefit be less than $25.00. CHANGES IN WEEKLY INCOME BENEFIT: Increases in the benefit amount are effective on the date of the change, provided the Insured is actively at work on the effective date of the change. If the Insured is not actively at work on that date, the effective date of the increase in the benefit amount will be deferred until the date the Insured returns to active work. Decreases in the benefit amount are effective on the date the change occurs. Premium changes due to an Insured's age will occur on the January 1st coinciding with or next following the birthday that causes the Insured to enter the next age bracket. If an increase in, or initial application for, the Weekly Income Benefit amount is due to a life event change (such as marriage, birth or specific changes in employment status), proof of good health will not be required for amounts up to the guaranteed issue amount, provided the Eligible Person applies within thirty-one (31) days of such life event. CONTRIBUTIONS: Person: 100% Contributions for the Insured are being made on a post-tax basis. For purposes of filing the Insured's Federal Income Tax Return, this means that under the law as of the date this Policy was issued, the Insured's Weekly Income Benefit might be treated as non-taxable. It is recommended that the Insured contact his/her personal tax advisor. LRS-6451-2-0113-IN Page 1.0