Accident Summary

ACCIDENT Accident Ultra Bene昀椀t Summary PLAN OVERVIEW INFORMA吀䤀ON Hours Worked: 30+ hours/week* Employer Contribu琀椀on: Voluntary Accident insurance provides payment for medical Eligible Group Size: 50-100 eligible employees** expenses due to a non-occupa琀椀onal accidental Par琀椀cipa琀椀on Requirement: injury. Payment is made directly to the employee 10 lives for groups with 50-100 eligible employees regardless of other health insurance coverage. *An employee must be actively at work on the effective date in order to be eligible for bene昀椀ts. Employers located in New York may elect a minimum of 20 or 30 hours. COVERED ACCIDENTAL INJURIES Sudden, unexpected, unintended, claimant had no control over, and not workplace related. Refer to the policy cer琀椀昀椀cate for a speci昀椀c list of excluded accidents. bene昀椀t period Medical expenses must be incurred within 180 days from the date of the covered accident LOSS period First treatment must occur within 30 days from the date of the covered accident. ANNUAL BENE䘀䤀T MAXIMUM Individual Aggregate Employee $3,000 $3,000 EE + Spouse $3,000 $6,000 EE + Children $3,000 $9,000 Family $3,000 $9,000 BEAM SUPPORT LEARN MORE support@beambene昀椀ts.com (800) 648 1179 beambene昀椀ts.com BM-SOB-0010-202401 Valid as of 11/15/22

Termination age Employee 65 Spouse 65 Child 26 (unmarried) ADDITIONAL SUMMARY DETAILS Eligibility Wai琀椀ng Period De昀椀ned by the Policyholder Annual enrollment and late entrant rules: Employees have 31 days from the plan e昀昀ec琀椀ve date or their eligibility date, whichever is later, to enroll or they are considered a late entrant. Late entrants must wait un琀椀l the next annual enrollment to enroll in the plan. These rules apply to both employee and dependent op琀椀ons. $50 per plan year, per individual Ambulance Benefit (For policies issued in DC only) BEAM SUPPORT LEARN MORE support@beambene昀椀ts.com (800) 648 1179 beambene昀椀ts.com BM-SOB-0010-202401 Valid as of 11/15/22

This benefit summary is not a complete description of the insurance coverage. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern. Accident insurance product is underwritten by Nationwide Life Insurance Company, Columbus, OH, marketed by Beam Insurance Services LLC (Beam Benefits Insurance Services LLC, in CA) and administered by Beam Insurance Administrators LLC (Beam Dental Insurance Administrators LLC in Texas). Accident coverage applicable to policy form GCAS AO L20, or state equivalent. Products are not available to members living in Puerto Rico and product availability may vary by state. Program restrictions and exclusions apply. 1099 Contractors are not eligible for coverage. Beam is not a subsidiary of Nationwide Life Insurance Company. Beam Insurance Services LLC and Beam Insurance Administrators LLC are separate companies and not affiliated with Nationwide Life Insurance Company Nationwide Life Insurance Company, One Nationwide Plaza, Columbus, OH 43215 BEAM SUPPORT LEARN MORE [email protected] | (800) 648 1179 beambenefits.com BM-SOB-0010-202401 Valid as of 11/15/22