NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS UNDER THE NORTH CAROLINA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT

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1 NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS UNDER THE NORTH CAROLINA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT Residents of North Carolina who purchase life insurance, annuities or health insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the North Carolina Life and Health Insurance Guaranty Association. The purpose of this association is to ensure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the guaranty association will assess its other member insurance companies for the money to pay the claims of insured persons who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the guaranty association is not unlimited, however. And, as noted in the box below, this protection is not a substitute for consumers' care in selecting companies that are well-managed and financially stable. The North Carolina Life and Health Insurance Guaranty Association may or may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in North Carolina. You should not rely on coverage by the North Carolina Life and Health Insurance Guaranty Association in selecting an insurance company or in selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. Insurance companies or their agents are required by law to give or send you this notice. However, insurance companies and their agents are prohibited by law from using the existence of the guaranty association to induce you to purchase any kind of insurance policy. The North Carolina Life and Health North Carolina Dept. of Insurance Insurance Guaranty Association Consumer Division P.O. Box P.O. Box Raleigh, North Carolina Raleigh, North Carolina The state law that provides for this safety-net coverage is called the North Carolina Life and Health Insurance Guaranty Association Act. On the back of this page is a brief summary of this law's coverages, exclusions and limits. This summary does not cover all provisions of the law, nor does it in any way change anyone's rights or obligations under the Act or the rights or obligations of the Association. COVERAGE Generally, individuals will be protected by the life and health insurance guaranty association if they live in this state and hold a life or health insurance contract, or an annuity, or if they are insured under a group insurance contract, issued by a member insurer. The beneficiaries, payees or assignees of insured persons are protected as well, even if they live in another state.

2 EXCLUSIONS FROM COVERAGE However, persons holding such policies are not protected by this association if: they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside that state); the insurer was not authorized to do business in this state; their policy was issued by a nonprofit hospital or medical services organization (such as Blue Cross), an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policyholder is subject to future assessments, or by an insurance exchange. The Association also does not provide coverage for: any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; any policy of reinsurance (unless an assumption certificate was issued); interest rate yields that exceed the average rate specified in the law; dividends; experience or other credits given in connection with the administration of a policy for a group contractholder; employers' plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them); unallocated annuity contracts (which give rights to group contractholders, not individuals), unless they fund a government lottery or a benefit plan of an employer, association or union, except the unallocated annuities issued to employee benefit plans protected by the Federal Pension Benefit Guaranty Corporation are not covered. LIMITS ON AMOUNT OF COVERAGE The act also limits the amount the association is obligated to pay out: The association cannot pay more than what the insurance company would owe under a policy or contract. Also, for any one individual, the association will pay a maximum of $300,000 - no matter how many policies and contracts there were with the same company, even if they provided different types of coverage. For any one groupholder of an unallocated annuity contract, the association will pay a maximum of $5,000,000.

3 READ YOUR POLICY CAREFULLY IMPORTANT CANCELLATION INFORMATION Please read the provisions entitled Termination of Insurance on the page indicated in the Table of Contents. TL

4 NOTICE UNDER NORTH CAROLINA GENERAL STATUTE SECTION , NO PERSON, EMPLOYER, PRINCIPAL, AGENT, TRUSTEE OR THIRD PARTY ADMINISTRATOR WHO IS RESPONSIBLE FOR THE PAYMENT OF GROUP HEALTH OR LIFE INSURANCE OR HEALTH CARE PLAN PREMIUMS SHALL: (1) CAUSE THE CANCELLATION OR NONRENEWAL OF GROUP HEALTH OR LIFE INSURANCE, HOSPITAL, MEDICAL OR DENTAL SERVICE PLAN, MULTIPLE EMPLOYER WELFARE ARRANGEMENT, OR HEALTH CARE PLAN COVERAGES AND THE CONSEQUENTIAL LOSS OF THE COVERAGES OF THE PERSONS INSURED BY WILLFULLY FAILING TO PAY SUCH PREMIUMS IN ACCORDANCE WITH THE TERMS OF THE INSURANCE OR PLAN CONTRACT, AND (2) WILLFULLY FAIL TO DELIVER, AT LEAST 45 DAYS PRIOR TO THE TERMINATION OF SUCH COVERAGES, TO ALL PERSONS COVERED BY THE GROUP POLICY A WRITTEN NOTICE OF THE PERSON'S INTENTION TO STOP PAYMENT OF PREMIUMS. THIS WRITTEN NOTICE MUST ALSO CONTAIN A NOTICE TO ALL PERSONS COVERED BY THE GROUP POLICY OF THEIR RIGHTS TO HEALTH INSURANCE CONVERSION POLICIES UNDER ARTICLE 53 OF GENERAL STATUTES CHAPTER 58 AND THEIR RIGHTS UNDER THE FEDERAL CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA). VIOLATION OF THIS LAW IS A FELONY. ANY PERSON VIOLATING THIS LAW IS ALSO SUBJECT TO A COURT ORDER REQUIRING THE PERSON TO COMPENSATE PERSONS INSURED FOR EXPENSES OR LOSSES INCURRED AS A RESULT OF THE TERMINATION OF THE INSURANCE. TL

5 NOTICE Benefits paid under the Accelerated Benefits provision will reduce the Death Benefit payable for life insurance. Benefits payable under the Accelerated Benefits provision may be taxable. If so, the Employee or the Employee's beneficiary may incur a tax obligation. As with all tax matters, an Employee should consult with a personal tax advisor to assess the impact of this benefit. Accelerated Benefits are not payable if life insurance coverage under the Policy is not in force. TL

6 LIFE INSURANCE COMPANY OF NORTH AMERICA 1601 CHESTNUT STREET GROUP POLICY PHILADELPHIA, PA (800) TDD (800) A STOCK INSURANCE COMPANY POLICYHOLDER: POLICY NUMBER: Wake Forest University FLX POLICY EFFECTIVE DATE: July 1, 2009 POLICY ANNIVERSARY DATE: July 1 This Policy describes the terms and conditions of coverage. It is issued in North Carolina and shall be governed by its laws. The Policy goes into effect on the Policy Effective Date, 12:01 a.m. at the Policyholder's address. In return for the required premium, the Insurance Company and the Policyholder have agreed to all the terms of this Policy. Scott Kern, Corporate Secretary Matthew G. Manders, Senior Vice-President TL

7 TABLE OF CONTENTS SCHEDULE OF BENEFITS... 1 SCHEDULE OF BENEFITS FOR CLASS SCHEDULE OF BENEFITS FOR CLASS SCHEDULE OF BENEFITS FOR CLASS SCHEDULE OF BENEFITS FOR CLASS SCHEDULE OF BENEFITS FOR CLASS SCHEDULE OF BENEFITS FOR CLASS SCHEDULE OF BENEFITS FOR CLASS SCHEDULE OF BENEFITS FOR CLASS ELIGIBILITY FOR INSURANCE EFFECTIVE DATE OF INSURANCE TERMINATION OF INSURANCE CONTINUATION OF INSURANCE LIFE INSURANCE BENEFITS LIFE INSURANCE EXCLUSIONS CLAIM PROVISIONS ADMINISTRATIVE PROVISIONS SCHEDULE OF RATES GENERAL PROVISIONS DEFINITIONS SCHEDULE OF AFFILIATES DOMESTIC PARTNER RIDER... 55

8 SCHEDULE OF BENEFITS Premium Due Date: The last day of each month Classes of Eligible Employees On the pages following the definition of eligible employees there is a Schedule of Benefits for each Class of Eligible Employees listed below. For an explanation of these benefits, please see the Description of Benefits provision. If an Employee is eligible under one Class of Eligible Employees and later becomes eligible under a different Class of Eligible Employees, changes in his or her insurance due to the class change will be effective on the first of the month coinciding with or next following date of change in class. Temporary employees and seasonal employees are not eligible for coverage under this Policy. Class 1 Class 2 Class 3 Class 4 Class 5 Class 6 Class 7 Class 8 All active, Full-time Employees of the Employer classified as a faculty member who are scheduled to work between 1096 and 1462 hours per year. All active, Full-time Employees of the Employer classified as a faculty member who are participating in the Phased Retirement Program. All active, Full-time Employees of the Employer classified as a staff member or administrator who are scheduled to work between 1400 and 2080 hours per year. All active, Full-time Employees of the Employer classified as a staff member or administrator who are participating in the Phased Retirement Program. All active, Full-time Employees of the Employer classified as Associate Provost, Controller, Dean of the Business School, Dean of the College, Dean of the Law School, Director of Athletics, General Counsel, Head Coach of Basketball, Head Coach of Football, President, Provost, Provost Emeritus, Senior Executive Assistant to the President, Senior Vice President or Vice President. All active, Full-time Employees of the Employer classified as Associate Provost, Controller, Dean of the Business School, Dean of the College, Dean of the Law School, Director of Athletics, General Counsel, Head Coach of Basketball, Head Coach of Football, President, Provost, Provost Emeritus, Senior Executive Assistant to the President, Senior Vice President or Vice President who are participating in the Phased Retirement Program. All active, part-time Employees of the Employer classified as a faculty member who are scheduled to work between 1000 and 1095 hours per year. All active, part-time Employees of the Employer classified as a staff member or administrator who are scheduled to work between 1000 and 1399 hours per year. 1

9 SCHEDULE OF BENEFITS FOR CLASS 1 Eligibility Waiting Period The Eligibility Waiting Period is the period of time the Employee must be in Active Service to be eligible for coverage. It will be extended by the number of days the Employee is not in Active Service. For Employees hired on or before the Policy Effective Date: For Employees hired after the Policy Effective Date: The first of the month coinciding with or next following your date of hire. The first of the month coinciding with or next following your date of hire. LIFE INSURANCE BENEFITS Employee Benefits Employees earning $50,000 or more annually Basic Benefit 1 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. Guaranteed Issue Amount: the lesser of 1 times Annual Compensation or $100,000 Maximum Benefit: the lesser of 1 times Annual Compensation or $100,000 Employees earning less than $50,000 annually Basic Benefit 1.5 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. Guaranteed Issue Amount: the lesser of 1.5 times Annual Compensation or $50,000 Maximum Benefit: the lesser of 1.5 times Annual Compensation or $50,000 Voluntary Benefit Minimum Benefit: $1,000 Guaranteed Issue Amount: 1, 2, 3, 4 or 5 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. the greater of a) or b) below: a) the lesser of 3 times Annual Compensation or $400,000, or b) an amount equal to the Life Insurance Benefit in effect on the termination date of the Prior Plan Maximum Benefit: the lesser of 5 times Annual Compensation or $500,000 Age Based Reductions Life Insurance Benefit for an Employee age 70 and over will reduce to: 65% of the Life Insurance Benefit at age 70 50% of the Life Insurance Benefit at age 75 2

10 Continuation Options For Leave of Absence Maximum Benefit Period: For Leave of Absence for Sabbatical Maximum Benefit Period: For Leave of Absence for Pregnancy Maximum Benefit Period: For Family Medical Leave Maximum Benefit Period: 24 months 24 months 4 months 6 months Extended Death Benefit with Waiver of Premium Extended Death Benefit Applicable Coverages Life Insurance Benefits for the Employee, his or her Spouse and Dependent Children, if any Waiver of Premium Waiver Waiting Period 6 months from the date the Employee's Active Service ends Maximum Benefit Period To age 70 Applicable Coverages Life Insurance Benefits for the Employee, his or her Spouse and Dependent Children, if any Portability Options For Employees See the Former Employee and Spouse/Domestic Partner of Former Employee sections in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill, subject to a Maximum Benefit of $450,000. Automatic Increase Feature If an Employee s Voluntary Life Insurance Benefit is based on Annual Compensation, it will automatically increase. The amount of the increase may be up to $25,000. It will automatically increase, subject to the conditions below. Conditions for Automatic Increase: 1. the Employer provides the Insurance Company with the required notice of an increase in Annual Compensation; and 2. the Employee is in Active Service on the effective date of the increase. If an Employee is not in Active Service on that date, his or her benefit will not increase until he or she returns to Active Service. The Employee may stop the Automatic Increase Feature at any time. If an Employee stops the feature, it may not be restarted at a later date. TL

11 Increases and Decreases in Coverage An eligible Employee may enroll for or increase his or her Voluntary Term Life Insurance Benefits, at any time, only if he or she satisfies the Insurability Requirement. Any amount the Insurance Company approves is effective on the date the Insurance Company agrees in writing to insure the Employee. An Employee may reduce Insurance Benefits at any time. The reduced amount will be effective on the date the Insurance Company receives the completed change form. Spouse Benefits or Domestic Partner Benefits Voluntary Benefit Option 1 $25,000 Option 2 $10,000 Guaranteed Issue Amount: the greater of a) or b) below: a) $25,000, or b) an amount equal to the Life Insurance Benefit in effect on the termination date of the Prior Plan Spouse or Domestic Partner s Life Insurance Benefits cannot exceed Employee s Life Insurance Benefits. Age Based Reductions Life Insurance Benefit for a Spouse or Domestic Partner age 70 and over will reduce to: 65% of the Life Insurance Benefit at age 70 50% of the Life Insurance Benefit at age 75 Portability Options For Spouse or Domestic Partner See the Former Spouse or Domestic Partner section in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. Dependent Child Benefits Voluntary Benefit Option 1 $10,000 Option 2 $5,000 The Maximum Benefit for a Dependent Child who is less than 6 months old is $500. Child s Life Insurance Benefits cannot exceed Employee s Life Insurance Benefits. All Dependent Child benefits are Guaranteed Issue. Portability Options For Dependent Children See the Former Dependent Child section in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 4

12 Former Employee Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Life Insurance Benefits allowable to an Employee, less any amount of conversion insurance issued under the Conversion Privilege for Life Insurance. Maximum Benefit Period To Age 70 Any amount elected in excess of the Life Insurance Benefits in effect on the date he or she no longer qualifies as an Employee will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill, subject to a Maximum Benefit of $450,000. Spouse or Domestic Partner of Former Employee Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Voluntary Life Insurance Benefits available to a Spouse or Domestic Partner. Maximum Benefit Period To Age 70 Any amount elected in excess of the Voluntary Life Insurance Benefits in effect on the date the Employee's employment with the Employer ends will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. Former Spouse or Domestic Partner Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Voluntary Life Insurance Benefits available to a Spouse or Domestic Partner. Maximum Benefit Period To Age 70 Any amount elected in excess of the Voluntary Life Insurance Benefits in effect on the date he or she no longer qualifies as a Spouse or Domestic Partner will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. 5

13 Former Dependent Child Benefits Amount of Insurance Units of $25,000 Guaranteed Issue Amount: $25,000 Maximum Benefit: $50,000 Maximum Benefit Period To Age 70 TL

14 SCHEDULE OF BENEFITS FOR CLASS 2 Eligibility Waiting Period The Eligibility Waiting Period is the period of time the Employee must be in Active Service to be eligible for coverage. It will be extended by the number of days the Employee is not in Active Service. For Employees hired on or before the Policy Effective Date: For Employees hired after the Policy Effective Date: No Waiting Period. No Waiting Period. LIFE INSURANCE BENEFITS Employee Benefits Basic Benefit Guaranteed Issue Amount: Maximum Benefit: An amount as on file with the Employer and the Insurance Company An amount as on file with the Employer and the Insurance Company An amount as on file with the Employer and the Insurance Company Voluntary Benefit Minimum Benefit: $1,000 Guaranteed Issue Amount: 1, 2, 3, 4 or 5 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. the greater of a) or b) below: a) the lesser of 3 times Annual Compensation or $400,000, or b) an amount equal to the Life Insurance Benefit in effect on the termination date of the Prior Plan Maximum Benefit: the lesser of 5 times Annual Compensation or $500,000 Age Based Reductions Life Insurance Benefit for an Employee age 70 and over will reduce to: 65% of the Life Insurance Benefit at age 70 50% of the Life Insurance Benefit at age 75 Continuation Options For Leave of Absence Maximum Benefit Period: For Leave of Absence for Sabbatical Maximum Benefit Period: For Leave of Absence for Pregnancy Maximum Benefit Period: For Family Medical Leave Maximum Benefit Period: 24 months 24 months 4 months 6 months 7

15 Waiver of Premium Portability Options For Employees This option does not apply to this class of Employee. See the Former Employee and Spouse/Domestic Partner of Former Employee sections in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill, subject to a Maximum Benefit of $500,000. Automatic Increase Feature If an Employee s Voluntary Life Insurance Benefit is based on Annual Compensation, it will automatically increase. The amount of the increase may be up to $25,000. It will automatically increase, subject to the conditions below. Conditions for Automatic Increase: 1. the Employer provides the Insurance Company with the required notice of an increase in Annual Compensation; and 2. the Employee is in Active Service on the effective date of the increase. If an Employee is not in Active Service on that date, his or her benefit will not increase until he or she returns to Active Service. The Employee may stop the Automatic Increase Feature at any time. If an Employee stops the feature, it may not be restarted at a later date. TL Increases and Decreases in Coverage An eligible Employee may enroll for or increase his or her Voluntary Term Life Insurance Benefits, at any time, only if he or she satisfies the Insurability Requirement. Any amount the Insurance Company approves is effective on the date the Insurance Company agrees in writing to insure the Employee. An Employee may reduce Insurance Benefits at any time. The reduced amount will be effective on the date the Insurance Company receives the completed change form. Spouse Benefits or Domestic Partner Benefits Voluntary Benefit Option 1 $25,000 Option 2 $10,000 Guaranteed Issue Amount: the greater of a) or b) below: a) $25,000, or b) an amount equal to the Life Insurance Benefit in effect on the termination date of the Prior Plan Spouse or Domestic Partner s Life Insurance Benefits cannot exceed Employee s Life Insurance Benefits. 8

16 Age Based Reductions Life Insurance Benefit for a Spouse or Domestic Partner age 70 and over will reduce to: 65% of the Life Insurance Benefit at age 70 50% of the Life Insurance Benefit at age 75 Portability Options For Spouse or Domestic Partner See the Former Spouse or Domestic Partner section in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. Dependent Child Benefits Voluntary Benefit Option 1 $10,000 Option 2 $5,000 The Maximum Benefit for a Dependent Child who is less than 6 months old is $500. Child s Life Insurance Benefits cannot exceed Employee s Life Insurance Benefits. All Dependent Child benefits are Guaranteed Issue. Portability Options For Dependent Children See the Former Dependent Child section in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. Former Employee Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Life Insurance Benefits allowable to an Employee, less any amount of conversion insurance issued under the Conversion Privilege for Life Insurance. Maximum Benefit Period To Age 70 Any amount elected in excess of the Life Insurance Benefits in effect on the date he or she no longer qualifies as an Employee will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill, subject to a Maximum Benefit of $500,000. 9

17 Spouse or Domestic Partner of Former Employee Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Voluntary Life Insurance Benefits available to a Spouse or Domestic Partner. Maximum Benefit Period To Age 70 Any amount elected in excess of the Voluntary Life Insurance Benefits in effect on the date the Employee's employment with the Employer ends will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. Former Spouse or Domestic Partner Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Voluntary Life Insurance Benefits available to a Spouse or Domestic Partner. Maximum Benefit Period To Age 70 Any amount elected in excess of the Voluntary Life Insurance Benefits in effect on the date he or she no longer qualifies as a Spouse or Domestic Partner will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. Former Dependent Child Benefits Amount of Insurance Units of $25,000 Guaranteed Issue Amount: $25,000 Maximum Benefit: $50,000 Maximum Benefit Period To Age 70 TL

18 SCHEDULE OF BENEFITS FOR CLASS 3 Eligibility Waiting Period The Eligibility Waiting Period is the period of time the Employee must be in Active Service to be eligible for coverage. It will be extended by the number of days the Employee is not in Active Service. For Employees hired on or before the Policy Effective Date: For Employees hired after the Policy Effective Date: The first of the month coinciding with or next following your date of hire. The first of the month coinciding with or next following your date of hire. LIFE INSURANCE BENEFITS Employee Benefits Employees earning $50,000 or more annually Basic Benefit 1 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. Guaranteed Issue Amount: the lesser of 1 times Annual Compensation or $100,000 Maximum Benefit: the lesser of 1 times Annual Compensation or $100,000 Employees earning less than $50,000 annually Basic Benefit 1.5 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. Guaranteed Issue Amount: the lesser of 1.5 times Annual Compensation or $50,000 Maximum Benefit: the lesser of 1.5 times Annual Compensation or $50,000 Voluntary Benefit Minimum Benefit: $1,000 Guaranteed Issue Amount: 1, 2, 3, 4 or 5 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. the greater of a) or b) below: a) the lesser of 3 times Annual Compensation or $400,000, or b) an amount equal to the Life Insurance Benefit in effect on the termination date of the Prior Plan Maximum Benefit: the lesser of 5 times Annual Compensation or $500,000 Age Based Reductions Life Insurance Benefit for an Employee age 70 and over will reduce to: 65% of the Life Insurance Benefit at age 70 50% of the Life Insurance Benefit at age 75 11

19 Continuation Options For Leave of Absence Maximum Benefit Period: For Leave of Absence for Sabbatical Maximum Benefit Period: For Leave of Absence for Pregnancy Maximum Benefit Period: For Family Medical Leave Maximum Benefit Period: 24 months 24 months 4 months 6 months Extended Death Benefit with Waiver of Premium Extended Death Benefit Applicable Coverages Life Insurance Benefits for the Employee, his or her Spouse and Dependent Children, if any Waiver of Premium Waiver Waiting Period 6 months from the date the Employee's Active Service ends Maximum Benefit Period To age 70 Applicable Coverages Life Insurance Benefits for the Employee, his or her Spouse and Dependent Children, if any Portability Options For Employees See the Former Employee and Spouse/Domestic Partner of Former Employee sections in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill, subject to a Maximum Benefit of $500,000. Automatic Increase Feature If an Employee s Voluntary Life Insurance Benefit is based on Annual Compensation, it will automatically increase. The amount of the increase may be up to $25,000. It will automatically increase, subject to the conditions below. Conditions for Automatic Increase: 1. the Employer provides the Insurance Company with the required notice of an increase in Annual Compensation; and 2. the Employee is in Active Service on the effective date of the increase. If an Employee is not in Active Service on that date, his or her benefit will not increase until he or she returns to Active Service. The Employee may stop the Automatic Increase Feature at any time. If an Employee stops the feature, it may not be restarted at a later date. TL

20 Increases and Decreases in Coverage An eligible Employee may enroll for or increase his or her Voluntary Term Life Insurance Benefits, at any time, only if he or she satisfies the Insurability Requirement. Any amount the Insurance Company approves is effective on the date the Insurance Company agrees in writing to insure the Employee. An Employee may reduce Insurance Benefits at any time. The reduced amount will be effective on the date the Insurance Company receives the completed change form. Spouse or Domestic Partner Benefits Voluntary Benefit Option 1 $25,000 Option 2 $10,000 Guaranteed Issue Amount: the greater of a) or b) below: a) $25,000, or b) an amount equal to the Life Insurance Benefit in effect on the termination date of the Prior Plan Spouse or Domestic Partner s Life Insurance Benefits cannot exceed Employee s Life Insurance Benefits. Age Based Reductions Life Insurance Benefit for a Spouse or Domestic Partner age 70 and over will reduce to: 65% of the Life Insurance Benefit at age 70 50% of the Life Insurance Benefit at age 75 Portability Options For Spouse or Domestic Partner See the Former Spouse or Domestic Partner section in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. Dependent Child Benefits Voluntary Benefit Option 1 $10,000 Option 2 $5,000 The Maximum Benefit for a Dependent Child who is less than 6 months old is $500. Child s Life Insurance Benefits cannot exceed Employee s Life Insurance Benefits. All Dependent Child benefits are Guaranteed Issue. Portability Options For Dependent Children See the Former Dependent Child section in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 13

21 Former Employee Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Life Insurance Benefits allowable to an Employee, less any amount of conversion insurance issued under the Conversion Privilege for Life Insurance. Maximum Benefit Period To Age 70 Any amount elected in excess of the Life Insurance Benefits in effect on the date he or she no longer qualifies as an Employee will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill, subject to a Maximum Benefit of $500,000. Spouse or Domestic Partner of Former Employee Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Voluntary Life Insurance Benefits available to a Spouse or Domestic Partner. Maximum Benefit Period To Age 70 Any amount elected in excess of the Voluntary Life Insurance Benefits in effect on the date the Employee's employment with the Employer ends will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. Former Spouse or Domestic Partner Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Voluntary Life Insurance Benefits available to a Spouse or Domestic Partner. Maximum Benefit Period To Age 70 Any amount elected in excess of the Voluntary Life Insurance Benefits in effect on the date he or she no longer qualifies as a Spouse or Domestic Partner will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. 14

22 Former Dependent Child Benefits Amount of Insurance Units of $25,000 Guaranteed Issue Amount: $25,000 Maximum Benefit: $50,000 Maximum Benefit Period To Age 70 TL

23 SCHEDULE OF BENEFITS FOR CLASS 4 Eligibility Waiting Period The Eligibility Waiting Period is the period of time the Employee must be in Active Service to be eligible for coverage. It will be extended by the number of days the Employee is not in Active Service. For Employees hired on or before the Policy Effective Date: For Employees hired after the Policy Effective Date: No Waiting Period. No Waiting Period. LIFE INSURANCE BENEFITS Employee Benefits Basic Benefit Guaranteed Issue Amount: Maximum Benefit: An amount as on file with the Employer and the Insurance Company An amount as on file with the Employer and the Insurance Company An amount as on file with the Employer and the Insurance Company Voluntary Benefit Minimum Benefit: $1,000 Guaranteed Issue Amount: 1, 2, 3, 4 or 5 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. the greater of a) or b) below: a) the lesser of 3 times Annual Compensation or $400,000, or b) an amount equal to the Life Insurance Benefit in effect on the termination date of the Prior Plan Maximum Benefit: the lesser of 5 times Annual Compensation or $500,000 Age Based Reductions Life Insurance Benefit for an Employee age 70 and over will reduce to: 65% of the Life Insurance Benefit at age 70 50% of the Life Insurance Benefit at age 75 Continuation Options For Leave of Absence Maximum Benefit Period: For Leave of Absence for Sabbatical Maximum Benefit Period: For Leave of Absence for Pregnancy Maximum Benefit Period: For Family Medical Leave Maximum Benefit Period: 24 months 24 months 4 months 6 months 16

24 Waiver of Premium This option does not apply to this class of Employee Portability Options For Employees See the Former Employee and Spouse/Domestic Partner of Former Employee sections in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill, subject to a Maximum Benefit of $500,000. Automatic Increase Feature If an Employee s Voluntary Life Insurance Benefit is based on Annual Compensation, it will automatically increase. The amount of the increase may be up to $25,000. It will automatically increase, subject to the conditions below. Conditions for Automatic Increase: 1. the Employer provides the Insurance Company with the required notice of an increase in Annual Compensation; and 2. the Employee is in Active Service on the effective date of the increase. If an Employee is not in Active Service on that date, his or her benefit will not increase until he or she returns to Active Service. The Employee may stop the Automatic Increase Feature at any time. If an Employee stops the feature, it may not be restarted at a later date. TL Increases and Decreases in Coverage An eligible Employee may enroll for or increase his or her Voluntary Term Life Insurance Benefits, at any time, only if he or she satisfies the Insurability Requirement. Any amount the Insurance Company approves is effective on the date the Insurance Company agrees in writing to insure the Employee. An Employee may reduce Insurance Benefits at any time. The reduced amount will be effective on the date the Insurance Company receives the completed change form. Spouse or Domestic Partner Benefits Voluntary Benefit Option 1 $25,000 Option 2 $10,000 Guaranteed Issue Amount: the greater of a) or b) below: a) $25,000, or b) an amount equal to the Life Insurance Benefit in effect on the termination date of the Prior Plan Spouse or Domestic Partner s Life Insurance Benefits cannot exceed Employee s Life Insurance Benefits. 17

25 Age Based Reductions Life Insurance Benefit for a Spouse or Domestic Partner age 70 and over will reduce to: 65% of the Life Insurance Benefit at age 70 50% of the Life Insurance Benefit at age 75 Portability Options For Spouse or Domestic Partner See the Former Spouse or Domestic Partner section in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. Dependent Child Benefits Voluntary Benefit Option 1 $10,000 Option 2 $5,000 The Maximum Benefit for a Dependent Child who is less than 6 months old is $500. Child s Life Insurance Benefits cannot exceed Employee s Life Insurance Benefits. All Dependent Child benefits are Guaranteed Issue. Portability Options For Dependent Children See the Former Dependent Child section in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. Former Employee Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Life Insurance Benefits allowable to an Employee, less any amount of conversion insurance issued under the Conversion Privilege for Life Insurance. Maximum Benefit Period To Age 70 Any amount elected in excess of the Life Insurance Benefits in effect on the date he or she no longer qualifies as an Employee will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill, subject to a Maximum Benefit of $500,

26 Spouse or Domestic Partner of Former Employee Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Voluntary Life Insurance Benefits available to a Spouse or Domestic Partner. Maximum Benefit Period To Age 70 Any amount elected in excess of the Voluntary Life Insurance Benefits in effect on the date the Employee's employment with the Employer ends will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. Former Spouse or Domestic Partner Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Voluntary Life Insurance Benefits available to a Spouse or Domestic Partner. Maximum Benefit Period To Age 70 Any amount elected in excess of the Voluntary Life Insurance Benefits in effect on the date he or she no longer qualifies as a Spouse or Domestic Partner will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. Former Dependent Child Benefits Amount of Insurance Units of $25,000 Guaranteed Issue Amount: $25,000 Maximum Benefit: $50,000 Maximum Benefit Period To Age 70 TL

27 SCHEDULE OF BENEFITS FOR CLASS 5 Eligibility Waiting Period The Eligibility Waiting Period is the period of time the Employee must be in Active Service to be eligible for coverage. It will be extended by the number of days the Employee is not in Active Service. For Employees hired on or before the Policy Effective Date: For Employees hired after the Policy Effective Date: The first of the month coinciding with or next following your date of hire. The first of the month coinciding with or next following your date of hire. LIFE INSURANCE BENEFITS Employee Benefits Basic Benefit 1 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. Guaranteed Issue Amount: the lesser of 1 times Annual Compensation or $100,000 Maximum Benefit: the lesser of 1 times Annual Compensation or $100,000 Voluntary Benefit (Employer-Paid) 2 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. Guaranteed Issue Amount: the lesser of 2 times Annual Compensation or $600,000 Maximum Benefit: the lesser of 2 times Annual Compensation or $600,000 Voluntary Benefit (Employee-Paid) Minimum Benefit: $1,000 Guaranteed Issue Amount: 1, 2 or 3 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. the greater of a) or b) below: a) the lesser of 2 times Annual Compensation or $600,000, or b) an amount equal to the Life Insurance Benefit in effect on the termination date of the Prior Plan Maximum Benefit: the lesser of 3 times Annual Compensation or $800,000 Combined Maximum Benefit: Age Based Reductions $1,500,000 for combined Basic, Employer-Paid Voluntary and Employee-Paid Voluntary Benefits Life Insurance Benefit for an Employee age 70 and over will reduce to: 65% of the Life Insurance Benefit at age 70 50% of the Life Insurance Benefit at age 75 20

28 Continuation Options For Leave of Absence Maximum Benefit Period: For Leave of Absence for Sabbatical Maximum Benefit Period: For Leave of Absence for Pregnancy Maximum Benefit Period: For Family Medical Leave Maximum Benefit Period: 24 months 24 months 4 months 6 months Extended Death Benefit with Waiver of Premium Extended Death Benefit Applicable Coverages Life Insurance Benefits for the Employee, his or her Spouse and Dependent Children, if any Waiver of Premium Waiver Waiting Period 6 months from the date the Employee's Active Service ends Maximum Benefit Period To age 70 Applicable Coverages Life Insurance Benefits for the Employee, his or her Spouse and Dependent Children, if any Portability Options For Employees See the Former Employee and Spouse/Domestic Partner of Former Employee sections in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill, subject to a Maximum Benefit of $500,000. Automatic Increase Feature If an Employee s Voluntary Life Insurance Benefit is based on Annual Compensation, it will automatically increase. The amount of the increase may be up to $25,000. It will automatically increase, subject to the conditions below. Conditions for Automatic Increase: 1. the Employer provides the Insurance Company with the required notice of an increase in Annual Compensation; and 2. the Employee is in Active Service on the effective date of the increase. If an Employee is not in Active Service on that date, his or her benefit will not increase until he or she returns to Active Service. The Employee may stop the Automatic Increase Feature at any time. If an Employee stops the feature, it may not be restarted at a later date. TL

29 Increases and Decreases in Coverage An eligible Employee may enroll for or increase his or her Voluntary Term Life Insurance Benefits, at any time, only if he or she satisfies the Insurability Requirement. Any amount the Insurance Company approves is effective on the date the Insurance Company agrees in writing to insure the Employee. An Employee may reduce Insurance Benefits at any time. The reduced amount will be effective on the date the Insurance Company receives the completed change form. Spouse or Domestic Partner Benefits Voluntary Benefit Option 1 $25,000 Option 2 $10,000 Guaranteed Issue Amount: the greater of a) or b) below: a) $25,000, or b) an amount equal to the Life Insurance Benefit in effect on the termination date of the Prior Plan Spouse or Domestic Partner s Life Insurance Benefits cannot exceed Employee s Life Insurance Benefits. Age Based Reductions Life Insurance Benefit for a Spouse or Domestic Partner age 70 and over will reduce to: 65% of the Life Insurance Benefit at age 70 50% of the Life Insurance Benefit at age 75 Portability Options For Spouse or Domestic Partner See the Former Spouse or Domestic Partner section in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. Dependent Child Benefits Voluntary Benefit Option 1 $10,000 Option 2 $5,000 The Maximum Benefit for a Dependent Child who is less than 6 months old is $500. Child s Life Insurance Benefits cannot exceed Employee s Life Insurance Benefits. All Dependent Child benefits are Guaranteed Issue. Portability Options For Dependent Children See the Former Dependent Child section in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 22

30 Former Employee Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Life Insurance Benefits allowable to an Employee, less any amount of conversion insurance issued under the Conversion Privilege for Life Insurance. Maximum Benefit Period To Age 70 Any amount elected in excess of the Life Insurance Benefits in effect on the date he or she no longer qualifies as an Employee will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill, subject to a Maximum Benefit of $500,000. Spouse or Domestic Partner of Former Employee Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Voluntary Life Insurance Benefits available to a Spouse or Domestic Partner. Maximum Benefit Period To Age 70 Any amount elected in excess of the Voluntary Life Insurance Benefits in effect on the date the Employee's employment with the Employer ends will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. Former Spouse or Domestic Partner Benefits Amount of Insurance An amount elected subject to the Maximum Benefit amount for Voluntary Life Insurance Benefits available to a Spouse or Domestic Partner. Maximum Benefit Period To Age 70 Any amount elected in excess of the Voluntary Life Insurance Benefits in effect on the date he or she no longer qualifies as a Spouse or Domestic Partner will be effective on the date the Insurance Company agrees in writing to insure him or her. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill. 23

31 Former Dependent Child Benefits Amount of Insurance Units of $25,000 Guaranteed Issue Amount: $25,000 Maximum Benefit: $50,000 Maximum Benefit Period To Age 70 TL

32 SCHEDULE OF BENEFITS FOR CLASS 6 Eligibility Waiting Period The Eligibility Waiting Period is the period of time the Employee must be in Active Service to be eligible for coverage. It will be extended by the number of days the Employee is not in Active Service. For Employees hired on or before the Policy Effective Date: For Employees hired after the Policy Effective Date: No Waiting Period. No Waiting Period. LIFE INSURANCE BENEFITS Employee Benefits Basic Benefit 1 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. Guaranteed Issue Amount: the lesser of 1 times Annual Compensation or $100,000 Maximum Benefit: the lesser of 1 times Annual Compensation or $100,000 Voluntary Benefit (Employer-Paid) 2 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. Guaranteed Issue Amount: the lesser of 2 times Annual Compensation or $600,000 Maximum Benefit: the lesser of 2 times Annual Compensation or $600,000 Voluntary Benefit (Employee-Paid) Minimum Benefit: $1,000 Guaranteed Issue Amount: 1, 2 or 3 times Annual Compensation rounded to the next higher $1,000, if not already a multiple thereof. the greater of a) or b) below: a) the lesser of 2 times Annual Compensation or $600,000, or b) an amount equal to the Life Insurance Benefit in effect on the termination date of the Prior Plan Maximum Benefit: the lesser of 3 times Annual Compensation or $800,000 Combined Maximum Benefit: Age Based Reductions $1,500,000 for combined Basic, Employer-Paid Voluntary and Employee-Paid Voluntary Benefits Life Insurance Benefit for an Employee age 70 and over will reduce to: 65% of the Life Insurance Benefit at age 70 50% of the Life Insurance Benefit at age 75 25

33 Continuation Options For Leave of Absence Maximum Benefit Period: For Leave of Absence for Sabbatical Maximum Benefit Period: For Leave of Absence for Pregnancy Maximum Benefit Period: For Family Medical Leave Maximum Benefit Period: Waiver of Premium Portability Options For Employees 24 months 24 months 4 months 6 months This option does not apply to this class of Employee. See the Former Employee sections in this Schedule of Benefits for the amounts of insurance an Insured is eligible to continue under this option. 75% of Life Insurance Benefits in force on the date the Insured is determined by the Insurance Company to be Terminally Ill, subject to a Maximum Benefit of $500,000. Automatic Increase Feature If an Employee s Voluntary Life Insurance Benefit is based on Annual Compensation, it will automatically increase. The amount of the increase may be up to $25,000. It will automatically increase, subject to the conditions below. Conditions for Automatic Increase: 1. the Employer provides the Insurance Company with the required notice of an increase in Annual Compensation; and 2. the Employee is in Active Service on the effective date of the increase. If an Employee is not in Active Service on that date, his or her benefit will not increase until he or she returns to Active Service. The Employee may stop the Automatic Increase Feature at any time. If an Employee stops the feature, it may not be restarted at a later date. TL Increases and Decreases in Coverage An eligible Employee may enroll for or increase his or her Voluntary Term Life Insurance Benefits, at any time, only if he or she satisfies the Insurability Requirement. Any amount the Insurance Company approves is effective on the date the Insurance Company agrees in writing to insure the Employee. An Employee may reduce Insurance Benefits at any time. The reduced amount will be effective on the date the Insurance Company receives the completed change form. 26