Calculating Your Cost Supplemental Employee Life: /1,000 = $ (volume) x (rate) Monthly Cost Supplemental Spouse Life: /1,000 = $ (volume) x (rate) Monthly Cost Supplemental Child Life: 0.037 /1,000 = $ (volume) x (rate) Monthly Cost Supplemental Employee AD&D: 0.016 /1,000 = $ (volume) x (rate) Monthly Cost Supplemental Spouse AD&D: 0.016 /1,000 = $ (volume) x (rate) Monthly Cost Supplemental Child AD&D: 0.016 /1,000 = $ (volume) x (rate) Monthly Cost This summary provides only a brief description of the Life Insurance coverage insured by Symetra Life Insurance Company under the LGC-13000 8/06 series Group Life Insurance policy. For a complete description, including all definitions, exclusions, limitations, and reductions in coverage, as well as information on termination of benefits, please contact your benefit administrator or refer to the Group Insurance Certificate you will receive when you become insured. Coverage will be offered under Group Policy number 01-020899-00. All benefits are subject to the terms and conditions of the Group Policy. If there is a difference between the information in this summary and the information contained in the Group Insurance Certificate, the terms of the Group Insurance Certificate will prevail. The terms of coverage may change over time; always refer to your current Group Insurance Certificate for information regarding your insurance benefits. Insured by Symetra Life Insurance Company Symetra® is a registered service mark of Symetra Life Insurance Company. LGP-2319/Other-Class 1 2/17