Accident Benefits Summary

Plan Summary for : 12856000 - Total Education Solutions Scheduled Benefit Accident EMERGENCY CARE & DIAGNOSTICS Plan 1 Plan 2 Ambulance - Ground $750 pp/pa $1,000 pp/pa 1 trip(s) per covered accident Ambulance - Air $2,000 pp/pa $2,000 pp/pa 1 trip(s) per covered accident Emergency Room $200 pp/pa $250 pp/pa 1 trip(s) per covered accident Major Diagnostic Testing $300 pp/pa $400 pp/pa (MRI, CT Scan, EEG) 1 exam(s) per covered accident X-Ray $150 pp/pa $200 pp/pa 1 test(s) per covered accident Pain Management/Epidural $50 pp/pa $75 pp/pa 1 visit(s) per covered accident Initial Doctor's Visit $100 pp/pa $150 pp/pa ACCIDENT HOSPITALIZATION & SURGICAL BENEFITS Hospital Admission $1,500 pp/pa $2,000 pp/pa ICU Admission $3,000 pp/pa $4,000 pp/pa Hospital Confinement $400 per day $600 per day Up to 365 day(s) per accident ICU $600 per day $800 per day Up to 30 day(s) per accident Rehabilitation/Skilled Nursing Facility $300 per day $420 per day Up to 90 day(s) per accident Blood/Plasma/Platelets $300 pp/pa $400 pp/pa Surgery - Open Abdominal, Thoracic $3,000 per surgery $4,000 per surgery Surgery - Cranial $3,000 per surgery $4,000 per surgery Surgery - Hernia $400 per surgery $600 per surgery Surgery - Exploratory or Without Repair $500 per surgery $750 per surgery Outpatient/Miscellaneous Surgery $200 per surgery $300 per surgery Transportation $600 per trip $800 per trip Up to 3 trip(s) per accident Family Lodging $150 per night $175 per night Up to 30 nights Coma $4,000 pp/pa $6,000 pp/pa After 7 day duration FOLLOW UP CARE Follow Up Doctor's Visit $100 pp/pa $150 pp/pa 1 visit(s) per covered accident Physical Therapy $75 per visit $100 per visit Up to 10 visits per accident Chiropractic Visit $75 per visit $100 per visit Up to 10 visits per accident Medical Equipment $200 pp/pa $300 pp/pa 1 appliance(s) per covered accident Prosthetic Device $1,500 pp/pa $2,000 pp/pa 1 device per covered accident COMMON INJURIES Burns Second Degree: 20 - 100 square centimeters $75 pp/pa $150 pp/pa Second Degree: 101 - 225 square centimeters $150 pp/pa $300 pp/pa

Second Degree: More than 225 square centimeters $500 pp/pa $1,000 pp/pa Third Degree: 20 - 100 square centimeters $1,000 pp/pa $2,000 pp/pa Third Degree: 101 - 225 square centimeters $3,000 pp/pa $5,000 pp/pa Third Degree: More than 225 square centimeters $15,000 pp/pa $20,000 pp/pa Skin Grafts 25% of burn benefit 25% of burn benefit Paralysis Quadriplegia $10,000 pp/pa $15,000 pp/pa Paraplegia $5,000 pp/pa $7,500 pp/pa Hemiplegia $5,000 pp/pa $7,500 pp/pa Uniplegia $2,500 pp/pa $3,750 pp/pa Lacerations Not requiring sutures $125 pp/pa $125 pp/pa Under 3 inches, required sutures $250 pp/pa $250 pp/pa 3 to 6 inches, requires sutures $500 pp/pa $500 pp/pa Over 6 inches, requires sutures $1,000 pp/pa $1,000 pp/pa Emergency Dental Work Crown Repair $450 pp/pa $600 pp/pa Extraction $225 pp/pa $300 pp/pa Eye Injuries Removal of Foreign Object $200 pp/pa $500 pp/pa Surgical Repair $750 pp/pa $1,000 pp/pa Specific Injuries Ruptured Disc $2,000 pp/pa $3,000 pp/pa Tendons/Ligaments $1,000 pp/pa $1,500 pp/pa 1 tear with surgical repair Tendons/Ligaments $2,000 pp/pa $3,000 pp/pa 2 or more tears with surgical repair Tendons/Ligaments $500 pp/pa $750 pp/pa Arthroscopic surgery with no repair Torn Knee Cartilage $500 pp/pa $750 pp/pa Exploratory surgery with no repair Torn Knee Cartilage $2,000 pp/pa $3,000 pp/pa Surgical repair Concussion $200 pp/pa $250 pp/pa Dislocations (Closed Reduction) 3 dislocation benefits per person, per accident maximum Hip $4,000 per dislocation $6,000 per dislocation Knee (except patella) $1,600 per dislocation $2,400 per dislocation Shoulder $1,600 per dislocation $2,400 per dislocation Foot/Ankle $1,600 per dislocation $2,400 per dislocation Wrist $1,600 per dislocation $2,400 per dislocation Lower Jaw $1,600 per dislocation $2,400 per dislocation Elbow $1,600 per dislocation $2,400 per dislocation Bones of the Hand (except fingers) $800 per dislocation $1,200 per dislocation Collarbone $800 per dislocation $1,200 per dislocation 2 or more fingers $250 per dislocation $450 per dislocation 2 or more toes $250 per dislocation $450 per dislocation 1 finger or toe $125 per dislocation $200 per dislocation Open Reduction 200% of dislocation benefit 200% of dislocation benefit Partial Dislocation 25% of dislocation benefit 25% of dislocation benefit Fractures (Closed Reduction) 3 fracture benefits per person, per accident maximum Skull $5,000 per fracture $6,000 per fracture Hip/Thigh $5,000 per fracture $6,000 per fracture Vertebral Body

(excluding vertebral processes) $5,000 per fracture $6,000 per fracture Pelvis $5,000 per fracture $6,000 per fracture Arm (upper) $3,250 per fracture $3,750 per fracture Shoulder Blade $3,250 per fracture $3,750 per fracture Leg $3,250 per fracture $3,750 per fracture Upper Jaw $2,000 per fracture $2,400 per fracture Vertebral Processes $2,000 per fracture $2,400 per fracture Knee Cap $2,000 per fracture $2,400 per fracture Collarbone $2,000 per fracture $2,400 per fracture Forearm $2,000 per fracture $2,400 per fracture Foot/Ankle $2,000 per fracture $2,400 per fracture Hand/Wrist $1,500 per fracture $1,875 per fracture Lower Jaw $1,500 per fracture $1,875 per fracture Ribs (2 or more) $1,000 per fracture $1,125 per fracture Facial Bones or Nose $1,000 per fracture $1,125 per fracture 1 rib, finger, or toe $500 per fracture $450 per fracture Coccyx $500 per fracture $450 per fracture Open Reduction 200% of fracture benefit 200% of fracture benefit Bone Chip 25% of fracture benefit 25% of fracture benefit CATASTROPHIC ACCIDENT BENEFITS Accidental Death1 $75,000 $100,000 Common Carrier Accidental Death1 $112,500 $150,000 1 AD&D Benefits Double Dismemberment Loss of both hands, both feet or sight in both eyes $75,000 $100,000 Loss of Speech or Hearing in both ears $37,500 $50,000 Loss of 1 hand and 1 foot $75,000 $100,000 Loss of 1 eye $37,500 $50,000 Loss of 1 hand or 1 foot $37,500 $50,000 Loss of 2 or more fingers or toes $15,000 $20,000 Loss of 1 finger or toe $3,750 $5,000 OPTIONAL BENEFITS Occupational Coverage Included Included Portability Included Included Monthly Premium Plan 1 Plan 2 Single $8.72 $12.26 Employee + Spouse $13.72 $19.29 Employee + Child(ren) $14.70 $20.64 Family $23.08 $32.41 1Benefit Amounts: Employee 100%, Spouse 50%, Child 25% 2pp/pa = per person/per accident To Calculate: Weekly=Monthly cost x 12 ÷52; Bi-Weekly =Monthly cost x 12÷26; Semi-Monthly=Monthly cost x 12 ÷24 Please refer to the Description of Benefits included in this packet for additional information on your benefits. These benefits are designed to be offered to those covered under a High-Deductible Health Plan ("HDHP") without the effect of disqualifying a participant from electing an HSA. Please consult with your Benefits Advisor to assist with determination that electing this limited benefit coverage is in fact permitted coverage under the rules applicable to an HSA. Scheduled Benefit Accident insurance policies are for accident only insurance and do not provide coverage for sickness. Select Benefits insurance policies are not a replacement for a major medical policy or other comprehensive coverage and do not satisfy the minimum essential coverage requirements of the Affordable Care Act. They are designed to provide benefits at a preselected, fixed-dollar amount. Coverage may be subject to exclusions, limitations, reductions, and termination of benefit provisions. Select Benefits policies are insured by Symetra Life Insurance Company located at 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004, and are not available in all U.S. states or any U.S. territory. Coverage is provided under policy form number SBC-03510.

Description of Benefits for : 12856000 - Total Education Solutions Scheduled Benefit Accident EMERGENCY CARE & DIAGNOSTICS Ambulance Transportation Benefit This benefit pays for ground or air ambulance transportation as shown in the Schedule of Benefits. It will be paid for transportation by a licensed ground or air ambulance transportation service from the place of injury to the nearest accredited hospital where adequate treatment facilities are available. Air ambulance transportation must be within 96 hours of the accident. Ground transportation must be within 90 days of the accident. Emergency Room Benefit The benefit amount shown in the Schedule of Benefits will be paid for treatment in an emergency room for an injury. Emergency room services must be incurred within 30 days from the Accident. Major Diagnostic Testing Benefit The benefit amount shown in the Schedule of Benefits will be paid if for any of the following major diagnostic tests as the result of the injury. Tests must be administered by a provider within 365 days of the accident. If multiple tests are performed, only one benefit will be paid. The following tests are covered: magnetic resonance imaging (MRI), computed tomography (CT, Cat Scan), electrocardiogram (EKG) and electroencephalogram. X-Ray Benefit The benefit amount shown in the Schedule of Benefits will be paid if an x-ray is performed as a result of the injury. The x-ray must be performed by a provider within 365 days of the accident. Pain Management/Epidural Benefit The benefit amount shown in the Schedule of Benefits will be paid if medical pain management services, including the application of epidural injections, are administered for treatment of injury. Services must be administered by a provider within 365 days of the accident. Services may be provided at the doctor's office, outpatient hospital clinic or urgent care facility. Initial Doctor Visit Benefit The benefit amount shown in the Schedule of Benefits will be paid for the first day of treatment from a doctor for an injury. The initial visit must occur within 365 days of the accident. Services must be provided at the doctor's office, an outpatient hospital clinic or urgent care facility. This benefit is payable once per person, per accident.

ACCIDENT HOSPITALIZATION & SURGICAL BENEFITS Hospital Admission Benefit This benefit will pay the amount shown in the Schedule of Benefits for the first calendar day of confinement and admission to a hospital as the result of an injury for a minimum of 24 consecutive hours or if a charge is made for room and board. Hospital admission must occur within 365 days from the date of the accident. The benefit is payable once per person, per accident. This benefit is payable regardless of other hospital benefits available. Intensive Care Unit (ICU) Admission Benefit This benefit will pay the amount shown in the Schedule of Benefits for the first calendar day of confinement and admission to an ICU as the result of an injury for a minimum of 24 consecutive hours or a charge is made for room and board. ICU admission must occur within 365 days from the date of the accident. The benefit is payable once per person, per accident. This benefit is payable regardless of other ICU benefits available. Hospital Confinement Benefit This benefit will pay the amount shown in the Schedule of Benefits for confinement to a hospital for treatment of injury. Hospital confinement must be for a minimum of 24 hours and begin within 365 days from the date of the accident. Intensive Care Unit (ICU) Confinement Benefit This benefit will pay the amount shown in the Schedule of Benefits for confinement to an ICU for treatment of injury. ICU confinement must be for a minimum of 24 hours and begin within 365 days from the date of the accident. Rehabilitation/Skilled Nursing Benefit This benefit will pay the amount shown in the Schedule of Benefits for confinement to a rehabilitation facility or skilled nursing facility for treatment of an injury. Confinement must be for a minimum of 24 hours and begin within 365 days from the date of the accident. Blood/Plasma/Platelets Benefit This benefit will pay the amount shown in the Schedule of Benefits for transfusion of blood, plasma or platelets for a surgical procedure. This benefit is paid one time per person, per accident. Surgery Benefit This benefit will pay the amount shown in the Schedule of Benefits based on the type of surgical procedure performed. Surgery must be performed within 365 days of date of the accident. If more than one surgical procedure is performed on the same day, the benefit paid will be based on the surgery that provides the largest benefit amount. Outpatient/Miscellaneous Surgery Benefit This benefit will pay the amount shown in the Schedule of Benefits for an outpatient surgical procedure or an inpatient surgical procedure not otherwise covered. Surgery must be required due to injury and performed within 365 days of the accident. This benefit is payable once per person, per accident.

Transportation Benefit This benefit will pay the amount shown in the Schedule of Benefits for each day an insured must travel to or from a health care facility more than 50 miles away from the primary residence for treatment of injury. Travel must occur within 365 days after the accident. Family Lodging Benefit This benefit will pay the amount shown in the Schedule of Benefits each day an expense is incurred for lodging by an adult family member or companion accompanying the insured who is confined as the result of an injury more than 50 miles away from the primary residence. This benefit is payable up to 30 nights per accident. Coma Benefit This benefit will pay the amount shown in the Schedule of Benefits if an insured lapses into a coma as the result of an injury. The coma must occur within 365 days of injury and last for a minimum of 7 days. FOLLOW UP CARE Follow Up Doctor's Visit Benefit This benefit will pay the amount shown in the Schedule of Benefits for a follow up visit with a doctor for the treatment of an injury. Treatment must be provided at a doctor's office, an outpatient hospital facility or urgent care facility and occur after initial treatment in a doctor's office or emergency room. Physical Therapy Benefit This benefit will pay the amount shown in the Schedule of Benefits for any day the insured receives physical therapy in a health care facility as the result of an injury. Physical therapy must begin within 365 days after the accident. This benefit is payable for up to 10 visits per accident. Chiropractic Visit Benefit This benefit will pay the amount shown in the Schedule of Benefits for each day the insured receives chiropractic care as the result of an injury. Chiropractic care must begin within 365 days after the date of the accident. This benefit is payable for up to 10 visits per accident. Medical Equipment Benefit This benefit will pay the amount shown in the Schedule of Benefits if the insured rents or buys durable medical equipment as the result of an injury. The medical equipment must be prescribed by a doctor within 365 days after the injury occurs. Prosthetic Device Benefit This benefit will pay the amount shown in the Schedule of Benefits if the insured purchases a prosthetic device as the result of an injury. The prosthetic device must be prescribed by a doctor within 365 days after the injury occurs.

COMMON INJURIES Burn Benefit This benefit will pay the amount shown in the Schedule of Benefits for second or third degree burns sustained due to an accident. Benefits are based on the severity of the burn. Only one benefit is payable per person, per accident. If multiple burns are sustained as the result of the same accident, the highest eligible benefit will be paid. Paralysis Benefit This benefit will pay the amount shown in the Schedule of Benefits for paralysis due to an accident. The benefit amount is based on the type of paralysis. Paralysis must be diagnosed by a doctor within 365 days of the accident. This benefit is payable only once per person, per accident. Laceration Benefit This benefit will pay the amount shown in the Schedule of Benefits for lacerations sustained as the result of an accident. The benefit amount is based on the type of laceration. Lacerations must be repaired within 96 hours after an accident. Only one laceration benefit will be paid per person, per accident. If multiple lacerations are sustained, the benefit amount applicable to the total length of all lacerations will be paid. Emergency Dental Work Benefit This benefit will pay the amount shown in the Schedule of Benefits if emergency dental treatment is required as the result of an accident. This includes the repair of a broken sound, natural tooth or crown and the extraction of a broken sound, natural tooth. The benefit amount is based on the type of procedure. Dental work must occur within 365 days after the accident. This benefit will be paid once per person, per accident regardless of the number of teeth involved. Eye Injury Benefit This benefit will pay the amount shown in the Schedule of Benefits if an eye injury is sustained as the result of an accident. The injury must require surgery or removal of a foreign object by a doctor within 365 days after the accident. One eye injury benefit is payable per person per accident. Specific Injury Benefit This benefit will pay the amount shown in the Schedule of Benefits if one of the specific injuries listed is sustained as the result of an accident. Benefit amounts are based on the type of injury sustained. The injury must require surgery or medical treatment within 365 days after the accident. Only one benefit is payable per person per accident. Dislocations Benefit This benefit will pay the amount shown in the Schedule of Benefits if a dislocation is sustained as the result of an accident. Benefit amounts are based on the type of dislocation sustained and must be treated by a doctor within 365 days after the accident. This benefit will be paid for up to 3 dislocations per person per accident.

Fractures Benefit This benefit will pay the amount shown in the Schedule of Benefits if a fracture is sustained as the result of an accident. Benefit amounts are based on the type of fracture sustained and must be treated by a doctor within 365 days after the accident. This benefit will be paid for up to 3 fractures per person per accident. CATASTROPHIC ACCIDENT BENEFITS Accidental Death Benefit This benefit will pay the amount shown in the Schedule of Benefits if the injury sustained results in loss of life. The loss must be a direct result of the accident, independent of all other causes and occur within 365 days of the accident. Common Carrier Accidental Death Benefit This benefit will pay the amount shown in the Schedule of Benefits if the injury sustained results in loss of life while on or occupying a common carrier. The loss must be a direct result of an accident, independent of all other causes and occur within 365 days of the accident. This benefit is payable in lieu of the Accidental Death benefit. Accidental Dismemberment Benefit This benefit will pay the amount shown in the Schedule of Benefits if the injury sustained results in a loss as described in the Schedule of Benefits. The loss must be a direct result of the accident, independent of all other causes and occur within 365 days of the accident. OPTIONAL RIDERS Portability/Extension of Coverage Allows coverage to continue following termination of employment or loss of eligibility. Review the certificate of coverage to understand the full details of this provision. If there is any conflict between this information and the policy issued, the terms of the policy will prevail. Scheduled Benefit Accident insurance policies are for accident only insurance and do not provide coverage for sickness. Select Benefits insurance policies are not a replacement for a major medical policy or other comprehensive coverage and do not satisfy the minimum essential coverage requirements of the Affordable Care Act. They are designed to provide benefits at a preselected, fixed-dollar amount. Coverage may be subject to exclusions, limitations, reductions, and termination of benefit provisions. Select Benefits policies are insured by Symetra Life Insurance Company located at 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004, and are not available in all U.S. states or any U.S. territory. Coverage is provided under policy form number SBC-03510.

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