Reliance Standard Voluntary Plans Critical Illness Insurance Premium Table Plan Holder: The Life is Good Company Scheduled Benefit: Each eligible employee may elect for himself and/or his eligible spouse an amount of insurance shown in the table below. Employee/Spouse Premiums: To find you and your spouse's premium - • Determine your age band: o Your age = your age at your last birthday. o Spouse age = your age at your last birthday. o For employees age 70 or older, benefit amounts are reduced according to the age-based reduction chart shown in the Plan Highlights. When selecting an amount of insurance, you must select at pre-age 70 benefit amount. • Select a benefit from: o Select an employee and spouse benefit from the table below. • Employee and spouse rates change as insured moves from one age bracket to the next, based on the age determination rules. Employee Weekly Premiums Benefit Amount Age 18-24 Age 25-29 Age 30-34 Age 35-39 Age 40-44 Age 45-49 Age 50-54 Age 55-59 Age 60-64 Age 65-69 Age 70+ $5,000 $0.72 $0.72 $0.92 $0.92 $1.72 $1.72 $3.30 $3.30 $5.82 $5.82 $10.60 $10,000 $1.43 $1.43 $1.85 $1.85 $3.44 $3.44 $6.60 $6.60 $11.63 $11.63 $21.21 $15,000 $2.15 $2.15 $2.77 $2.77 $5.16 $5.16 $9.90 $9.90 $17.45 $17.45 $31.81 $20,000 $2.86 $2.86 $3.69 $3.69 $6.88 $6.88 $13.20 $13.20 $23.26 $23.26 $42.42 Spouse Weekly Premiums Benefit Amount Age 18-24 Age 25-29 Age 30-34 Age 35-39 Age 40-44 Age 45-49 Age 50-54 Age 55-59 Age 60-64 Age 65-69 Age 70+ $5,000 $0.72 $0.72 $0.92 $0.92 $1.72 $1.72 $3.30 $3.30 $5.82 $5.82 $10.60 $10,000 $1.43 $1.43 $1.85 $1.85 $3.44 $3.44 $6.60 $6.60 $11.63 $11.63 $21.21 Dependent Child(ren): Your dependent child(ren) is eligible for a benefit amount of 25% of your Critical Illness benefit election, limited to a maximum of $5,000 To calculate Dependent Child(ren) Benefit: Employee Benefit Amount x 25% = Dependent Child(ren) Benefit. No rounding needed. To calculate Weekly Dependent Child(ren) Premium: Dependent Child(ren) Benefit/1000 x 0.06 Please Note: One rate and benefit amount for all eligible children in family, regardless of number. Please read this important information - You may not have coverage as both an employee and as a dependent. - Employee must have coverage in order for spouse and dependent children to be covered. Please note, these rates are approximate and subject to change.