www.reliancematrix.com Reliance Standard Life Insurance Company (Home Office Schaumburg, IL) is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. First Reliance Standard Life Insurance Company (Home Office New York, NY) is licensed in New York and Delaware. Standard Security Life Insurance Company of New York (Home Office New York, NY) is licensed in all states. Absence services are provided by Matrix Absence Management, Inc. Product features and availability may vary by state. INCLUDED BENEFITS Benefits Standard Hospital Admission Amount $1,500 Hospital Admission Max Per Year 1 Hospital Admission ICU Amount $1,500 Hospital Admission ICU Max Per Year 1 Hospital Confinement Amount $100 Hospital Confinement Days Max Per Year 60 Hospital Confinement ICU Amount $200 Hospital Confinement ICU Days Max Per Year 30 Minimum Hours for Admission or Confinement 23 Maximum Benefit per Plan Year Unlimited Nursery Admission Amount $250 Nursery Admission Max Per Year 1 Nursery Confinement Amount $50 Nursery Confinement Days Max Per Year 10 Portability Included Benefit Waiting Period None Benefit Waiting Period for Late Applicants None Pregnancy Limitation Period None Pre-Existing Limitation None Pre-Existing Limitation for Late Applicants This plan does not allow for Late Applicants. Wellness Benefit $50 *Note If more than one type of Hospital Admission occurs during the same Confinement, only the highest Hospital Admission Benefit is payable **Note If more than one type of Hospital Confinement occurs on the same day, only the highest Hospital Confinement Benefit is payable. EXCLUSIONS and LIMITATIONS A benefit will not be paid for a Covered Event if caused or contributed by an exclusion listed in the Certificate of Insurance. NON-INSURANCE SERVICES 1. Travel Assistance Services ADDITIONAL INFORMATION This Plan Highlights document provides a brief description of the key features of the Reliance Standard Life Insurance Company insurance plan. The availability of the benefits and features described may vary by state. It is not a Certificate of Insurance or evidence of coverage. Insurance is provided under group policy form LRS‐9572-0519, et al.