Page 2 Portability To age 70 | Coverage Basis 24-Hour Benefit plan and Features - Low Plan Class definition: Class 1 – All Active Full Time Employees Life and dismemberment losses Employee Spouse Child Accidental Death $25,000 $25,000 $12,500 Accidental Death Common Carrier $50,000 $50,000 $25,000 Catastrophic loss: loss of arm or loss of hand — both arms or both hands, loss of leg or loss of foot — both legs or both feet, loss of hand and loss of foot or loss of arm and loss of leg — one hand and one foot or one arm and one leg, loss of an ear — both ears, irrecoverable loss of hearing — both ears, loss of an eye — both eyes, irrecoverable loss of sight — both eyes, irrecoverable loss of speech or ability to speak, or any combination equaling two or more losses from: loss of arm, loss of hand, loss of leg, loss of foot, loss of an ear or loss of an eye $12,500 $12,500 $6,250 Accidental dismemberment Employee Spouse Child Loss of hand — one hand, Loss of foot — one foot, Loss of leg — one leg or loss of arm — one arm $5,000 $5,000 $2,500 Loss of a finger or loss of a toe — two or more fingers or toes $1,500 $1,500 $750 Loss of a finger or loss of a toe — one finger or one toe $500 $500 $250 Loss of hearing or loss of an ear — one ear $5,000 $5,000 $2,500 Loss of sight or loss of an eye — one eye $5,000 $5,000 $2,500 Dislocations (Open reduction/Closed reduction) Employee Spouse Child Hip $5,000/$2,500 $5,000/$2,500 $5,000/$2,500 Knee, ankle or bones of the foot $2,000/$1,000 $2,000/$1,000 $2,000/$1,000 Elbow or wrist $800/$400 $800/$400 $800/$400 Shoulder $1,000/$500 $1,000/$500 $1,000/$500 Collarbone or bones of the hand $1,500/$750 $1,500/$750 $1,500/$750 Finger(s) or toe(s) $300/$150 $300/$150 $300/$150 Lower jaw $800/$400 $800/$400 $800/$400 Incomplete dislocation 25% of the applicable closed reduction