Aspire Loyalty Program Insurance Benefit Guide

LEVEL UP YOUR LOYALTY

REWARDS

Your Insurance Bonus Benefit Guide

PARTNERED WITH

SECTION OFFERING OVERVIEW ONEAMERICA PRODUCTS CAREINGTON PRODUCTS ENROLLMENT GUIDE ONEAMERICA RATE TABLES

OFFERING OVERVIEW

THE BENEFIT OF BENEFITS There are sayings about the buddy system and safety in numbers for a reason.

Sharing the burden across a larger pool of people helps lower the impact felt by each person. This same idea holds true for insurance. Normally, premiums are shared across a group as a pool which works great for larger groups that have more people to share the risk. However, this can become an absolute nightmare for any group that has less than 100 lives. Groups of this size or smaller face two separate options:

Keeping Elections Separated There's nothing wrong with reaching out to individual carriers in order to sign up for their benefits as a small group! There may be more to juggle between the various carriers that are selected, but there are always benefits to Benefits!

Keep in mind that there may be plan limitations as the group size shrinks as well as the knowledge that the rates are likely to be higher than average.

Stay Stronger Together Through the Signia Aspire program, we're able to shift the thinking around what comprises a group. This means that instead of viewing you as solo participants, we can empower you and give you more purchasing power as part of a larger group. This way the risk is shared among fellow loyalty members and you reap the benefits that come with being part of a larger pool!

ONEAMERICA PRODUCTS

ASPIRE LOYALTY REWARDS PROGRAM

Provide affordable protection from life’s unexpected events with flexible coverage options and guaranteed issue LIFE OPTION Voluntary Life with AD&D: ✓ Benefit Amount = $10,000 - $300,000 (not to exceed five times employee’s annual base salary)

✓ Guaranteed Issue = $50,000 ✓ Dependent Life Optional

DISABILITY OPTIONS Short-Term Disability: ✓ Weekly Maximum = $500 ✓ Elimination Period = 14 days ✓ Benefit Duration = 13 weeks ✓ Benefit Percentage = 60% Long-Term Disability: ✓ Monthly maximum = $ 6000 ✓ Elimination Period = 90 days ✓ Benefit Duration = 2 years to age 70 ✓ Benefit Percentage = 60%

Note: Products issued and underwritten by American United Life Insurance Company® (AUL), a OneAmerica company. Not available in all states or may vary by state.

Brought to you by Signia Aspire as an optional Bonus Benefit.

See the Aspire portal for more information to get started.

Term Life Highlights Signa Aspire is providing you with Term Life and AD&D insurance from OneAmerica®.

What is Term Life insurance?

Term Life insurance is coverage provided by Signa Aspire that lasts for a set period of time. While you’re working, it can be used to ensure your family is able to replace your earnings and potential future earnings if you die. That money can be used to pay your final expenses and to cover housing, household debts, education and more when your income is no longer available. Having Term Life insurance can help provide peace of mind that your family will be protected.

What is accidental death and dismemberment?

If death is the result of an accident, such as a car accident or workplace accident, beneficiaries may receive an additional benefit as stated in your certificate.

How much does it cost?

Prices vary; See pricing grid for more information. Aspire owners can apply Aspire insurance credit to cover costs.

What is the benefit amount?  Your benefit is $50,000  Your guarantee issue amount is $50,000 Who is Eligible?

All full-time eligible Aspire members not located in New York or Puerto Rico.

What is a beneficiary?

Your beneficiary is who you leave your life insurance benefit to when you die. You can name one or more primary beneficiaries. If your primary beneficiary dies before you, your contingent or secondary beneficiary (or beneficiaries) will receive your life insurance benefit.

Please note any claim payment to a minor child would require a legal custodian to be appointed. Refer to this page for more information on selecting a beneficiary. It’s a good idea to review your beneficiaries at least once a year to ensure your information is up to date.

Note: Products issued and underwritten by American United Life Insurance Company® (AUL), Indianapolis, IN, a OneAmerica company. Not Available in all states or may vary by state.

is the marketing name for the companies of OneAmerica | OneAmerica.com © 2020 OneAmerica Financial Partners, Inc. All rights reserved.

Long-term Disability Highlights Signa Aspire is providing Long-term Disability insurance for you from OneAmerica®.

What is Long-term Disability insurance?

Long-term Disability (LTD) insurance protects your paycheck if you become sick or injured for a long period of time.

LTD benefits begin on the 91st day of total disability and pay a portion of your monthly wages.

What does it cover?

Long-term Disability insurance can help you maintain financial stability when you are sick or injured by safeguarding your income. It can also provide access to rehabilitation resources that can help you get back to work.

How much does it cost?

Prices vary; See pricing grid for more information. Aspire owners can apply Aspire insurance credit to cover costs.

What is the benefit amount?

Your benefit is 60% of your monthly pre-disability earnings, up to a maximum monthly benefit of $6,000.

How long will I receive benefits?

Your maximum benefit duration depends on your age when disability begins and lasts up to 2 years to age 70. [Reduced Benefits Duration table is available upon request.]

Who is eligible?

All full-time eligible Aspire members not located in New York, California or Puerto Rico.

What benefits are included in my policy?  Waiver of premium  Survivor benefit  Return to work incentives  Recurrent disability  Workplace modification benefit What limitations does this coverage have?  

Pre-existing condition limitation –3/12 Mental illness 2 years

is the marketing name for the companies of OneAmerica | OneAmerica.com © 2020 OneAmerica Financial Partners, Inc. All rights reserved.

 

Drug and alcohol abuse 2 years Special Conditions 2 years

These highlights are a brief description of the key features of the LTD insurance policy. Enroll timely for guarantee issue. You may not have another chance to elect coverage until your next open enrollment. The availability of the benefits and features described may vary by state. It is neither a certificate of insurance nor evidence of coverage. For more information, please reach out to your benefits representative.

Note: Products issued and underwritten by American United Life Insurance Company® (AUL), Indianapolis, IN, a OneAmerica company. Not Available in all states or may vary by state.

is the marketing name for the companies of OneAmerica | OneAmerica.com © 2020 OneAmerica Financial Partners, Inc. All rights reserved.

Short-term Disability Highlights Signa Aspire is providing Short-term Disability insurance to you from OneAmerica®.

What is Short-term Disability insurance?

Short-term Disability (STD) insurance protects your paycheck if you become sick or injured for a short period of time. STD benefits begin on the 14th day of total disability for injury and on 14th day of total disability for illness and pay a portion of your weekly wages.

What does it cover?

Short-term Disability insurance can help you maintain financial stability when you are sick or injured by safeguarding your income. It can also provide access to rehabilitation resources that can help you get back to work.

What does it cover?

Prices vary; See pricing grid for more information. Aspire owners can apply Aspire insurance credit to cover costs.

What is the benefit amount?

Your benefit is 60 percent of your weekly pre-disability earnings, up to a maximum weekly benefit of $500.

The minimum weekly benefit is $25 How long will I receive benefits?

Your maximum benefit duration can last up to 13 weeks based on the date your approved disability begins.

Who is eligible?

All full-time eligible Aspire members not located in New York, California or Puerto Rico.

What benefits are included in my policy?  Partial disability  Maternity coverage  Recurrent disability

is the marketing name for the companies of OneAmerica | OneAmerica.com © 2020 OneAmerica Financial Partners, Inc. All rights reserved.

What limitations does this coverage have?  Pre-existing condition limitation – 3/12 for groups of 2-9 eligible employees.

These highlights are a brief description of the key features of the STD insurance policy. Enroll timely for guarantee issue. You may not have another chance to elect coverage until your next open enrollment. The availability of the benefits and features described may vary by state. It is neither a certificate of insurance nor evidence of coverage. For more information, please reach out to your benefits representative.

Note: Products issued and underwritten by American United Life Insurance Company® (AUL), Indianapolis, IN, a OneAmerica company.

Not Available in all states or may vary by state.

is the marketing name for the companies of OneAmerica | OneAmerica.com © 2020 OneAmerica Financial Partners, Inc. All rights reserved.

Voluntary Term Life Highlights Signa Aspire is offering you the option to purchase Voluntary Term Life and AD&D insurance from OneAmerica®.

What is Voluntary Term Life insurance?

Voluntary Term Life insurance is life insurance that you purchase for a set period of time. It can be used to ensure your family is able to replace your earnings and potential future earnings if you die. That money can be used to pay your final expenses and to cover housing, household debts, education and more when your income is no longer available. Having Voluntary Term Life insurance is a way to have peace of mind that your family will be protected.

What is accidental death and dismemberment?

If death is the result of an accident, such as a car accident or workplace accident, beneficiaries may receive an additional benefit as stated in your certificate.

Why should I buy it?

Buying term life insurance through work is more affordable than trying to purchase it on your own because you’re getting a group rate. That means you can also have the option of purchasing more protection than you might otherwise. It is a flexible benefit that is designed to fit your budget. You can get started with as little as $10,000 and can increase your benefit on an annual basis by the greater of 10% or $10,000, allowing you to build up your benefit over time.

Another reason to purchase Voluntary Term Life insurance during this open enrollment period is that you can qualify without having to answer medical questions or undergo an exam. If you waive coverage but later elect Voluntary Term Life, evidence of insurability will be required.

How much does it cost?

The cost is based on your age and how much coverage you want to purchase. Premiums are calculated in five-year age brackets. Life insurance for your spouse and dependent children have separate premiums. Please refer to the cost illustrations for your benefit.

What is the benefit amount?  You may elect a benefit amount in increments of $1,000 from a minimum of $10,000 to a maximum of $300,000  You may elect a benefit up to the plan maximum not to exceed 5 times your annual base salary.  Your guarantee issue amount is $50,000  Your spouse may elect a benefit amount in increments of $500 from a minimum of $5,000 to a maximum of $150,000



Your spouse guarantee issue amount is $25,000



You have four options for dependent children: $2,500, $5,000, $7,500 or $10,000.

is the marketing name for the companies of OneAmerica | OneAmerica.com © 2020 OneAmerica Financial Partners, Inc. All rights reserved.

Who is Eligible?

All full-time eligible Aspire members not located in New York or Puerto Rico.

What is a beneficiary?

Your beneficiary is who you leave your life insurance benefit to when you die. You can name one or more primary beneficiaries. If your primary beneficiary dies before you, your contingent or secondary beneficiary (or beneficiaries) will receive your life insurance benefit.

Please note any claim payment to a minor child would require a legal custodian to be appointed. Refer to this page for more information on selecting a beneficiary. It’s a good idea to review your beneficiaries at least once a year to ensure your information is up to date.

Note: Products issued and underwritten by American United Life Insurance Company® (AUL), Indianapolis, IN, a OneAmerica company. Not Available in all states or may vary by state.

is the marketing name for the companies of OneAmerica | OneAmerica.com © 2020 OneAmerica Financial Partners, Inc. All rights reserved.

CAREINGTON PRODUCTS

The Best Things Come in 3s Health, wellness & lifestyle plans that deliver big discounts, less out-of-pocket costs

1 Live Healthy Dental & Vision Plan Affordable care is at your fingertips with this innovative plan that offers discounts on dental and vision services, as well as telehealth appointments for non-emergency illness and mental health support.

What’s Included:

Dental Discounts

Mental Wellness

Save 5% to 60% on most dental procedures including routine oral exams, unlimited cleanings and major work such as dentures, root canals and crowns through one of the largest dental networks nationally with a focus on neighborhood dentists.

DialCare Mental Wellness is a program designed to provide safe, secure and private means of seeking mental health assistance from licensed mental health professionals via virtual or telephonic counseling sessions.

Vision Discounts

Vision Correction Surgery

VSP Vision Savings Pass is a discount vision program that offers savings on eye care and eyewear. Members receive Exclusive Member Extras and special offers in addition to access to discounts through trusted, private-practice VSP doctors on eye and contact lens exams, glasses, and sunglasses.

This plan is not insurance.

Not available in WA.

Physician Access DialCare Physician Access is a modern, easy-to-use telemedicine solution for non-emergency illnesses and general care. Members and their families have direct access to state-licensed and fully credentialed doctors, via phone or video consultations, to receive treatment and advice for common ailments, including colds, the flu, rashes and more.

Members will receive savings of 40% to 50% off the overall national average cost for Traditional LASIK surgery through QualSight at over 1,000 locations.

The QualSight program is not an insured program.

Prescription Discounts Members have access to prescription drug savings that can be between 15% to 60% off the retail price of generic drugs and 10% to 25% off the retail price of brand name drugs at over 68,000 participating pharmacies nationwide.

Health Information eDocAmerica is an online health and wellness service that provides 24/7 unlimited access to physicians, psychologists, pharmacists, dentists, dietitians, fitness trainers, alternative medicine doctors and eye doctors for routine medical questions and information.

2 CareShield Identity Protection Plan Get access to legal and financial counseling, 24/7 online identity monitoring and a travel security package including a personal VPN, secure email account and a digital vault.

What’s Included:

Identity Monitoring & Restoration

Allstate Identity Protection provides proactive and industryleading identity monitoring to detect fraud sooner than competitors. The Allstate Identity Protection team includes privacy advocates who are certified and trained experts in identity theft restoration. If you indicate an alert seems suspicious, a privacy advocate will contact you by phone and serve as a dedicated case manager throughout the remediation process. *The membership plan includes the primary registered member plus up to four additional family members living in the household.

Travel Security

Members have access to the Travel Security package from Guard Street. This package features a Personal VPN, Secure Email Account and a Secure Digital Vault.

Legal Services

Legal Access Plans provides members and their families access to a nationwide network of over 20,000 attorneys that have contracted with Legal Access Plans to provide free and discounted legal services. This program provides initial face-to-face or phone consultations with licensed attorneys who will help analyze legal problems, suggest options and recommend a course of action.

Financial Services

Financial counseling on demand provides members with a broad array of practical financial counseling services when they have questions and need assistance. askAFS services include access to accredited, certified financial counselors by way of a live telephonic counseling helpline and online information, educational and referral resources.

3 Spree Discount Plan In addition to savings on everyday purchases like food, groceries and entertainment, this plan offers discounts on veterinary care and access to a 24/7 pet helpline.

What’s Included:

Veterinary Discounts

Pet Assure is a veterinary discount plan. Accepted at over 2,600 veterinarians, Pet Assure is a plan designed to give you peaceof-mind knowing you can better provide for your pet(s) without breaking the bank.

24-Hour Pet Helpline

Members have access to trusted and knowledgeable veterinary experts for pet advice for their dogs and cats when they need it most. Whether their dog got into something he shouldn’t have, or their cat is sleeping in unusual places or has a change in appetite, our pet experts at whiskerDocs can help 24/7.

Plan Pricing

Shopping Network

With the Everyday Discounts program provided by Access Development, there’s never a need to wait for a sale or hunt for a bargain; members can enjoy savings in their own neighborhood.

Members always save big with discounts from 10% to 50% off at popular retailers nationwide. Finding what members want at a great price is easy, and saving is even easier! This program will give members access to over 250,000 retailers and over 500 national brands, so members can find exactly what they are looking for.

Live Healthy Dental & Vision Plan: Member Only $17.00/month Member +1 $22.00/month | Member + Family $25.00/month CareShield Identity Protection Plan: $14.96/month Spree Discount Plan: $12.42/month

Disclosure: THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance. This plan does not meet the minimum creditable coverage requirements under M.G.L. c.111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act. This is not a Medicare prescription drug plan. The range of discounts will vary depending on the type of provider and service. The plan does not pay providers directly. Plan members must pay for all services but will receive a discount from participating providers. The list of participating providers is at www.mybenefitshub.com/careington. A written list of participating providers is available upon request.

You may cancel within the first 30 days after effective date or receipt of membership materials (whichever is later) and receive a full refund. Discount Plan Organization and administrator: Careington International Corporation, 7400 Gaylord Parkway, Frisco, TX 75034; phone 800-441-0380. This plan is not available in Vermont or Washington.

ENROLLMENT GUIDE

ENROLLMENT OVERVIEW THEbenefitsHUB gives you access to your benefits and information from anywhere that you have internet connection! This guide is meant to walk you through the simple enrollment process, taking you page-by-page through your enrollment screens and providing information on how to efficiently complete your enrollment walk-through!

LOGGING IN When you log in for the first time, you will be asked to change your password and/or electronically sign two acknowledgement pages. Outlined below is how to complete these actions, and what they mean. The entire enrollment experience should take about 20-25 minutes to complete.

Change Password When logging in for the first time, you will be brought to a page prompting you to update your password for security. Once your new password has been set, click

Save and Continue to move onto the next step of the

process.

Acknowledgments The System Acknowledgements page is displayed when you log in to the system. Read this section carefully as it contains disclaimer information and requires an electronic signature.

To continue in the online enrollment process, read through each section, checking each applicable box to signify acceptance of the acknowledgment.

When you have checked all applicable boxes, click

I Acknowledge at the bottom of the page to proceed.

Note that by clicking this button, you are agreeing to the terms.

DEMOGRAPHIC INFORMATION The Onboarding process requires you to enter or confirm your demographic information. You will need to review any pre-filled information for accuracy. Complete new or missing information and click on the

Save and Continue button when you are ready to proceed to the next step.

Please Note: All fields in

BOLD are required.

Personal Information In addition to any other information, enter an email address if you have one. If you need to use the Forgot Password link on the Login page, the system will deliver your new login credentials to this email address.

To add a dependent, click on the

+ icon. To edit an existing dependent, click on the

icon or

Save button after successfully adding information for each dependent. Click Save and Continue at the bottom of the page after all dependents have the name of the dependent listed. Click on the

been added.

Please make sure to indicate if your child is a full-time student and/or claimed on your tax return as this could affect eligibility on some benefit plans!

To revisit any of the sections mentioned select the

Back button to return to the previous page.

BENEFITS ENROLLMENT When you have completely entered all of your personal and dependent information, you will begin your online enrollment for the benefits that are available to you. Each benefit will appear on individual pages for your review. Choose your election and then click the to the next benefit.

Save and Continue button to proceed

Viewing Plan Information The broker or benefits administrator may have added important information regarding specific plan features or disclaimers. The top of the enrollment page may contain sections with plan information, as well as links to plan documents and websites. If multiple types of plans are available within the same benefit, you will see tabs at the top of the enrollment page; select a tab to see the documents and information applicable to that plan type.

Product Education Videos Some products may have videos to explain the purpose, function, and importance of the benefit. These videos will display in the top-left of the enrollment page. If multiple videos are available, you may click the arrows beneath the video to switch to the next one.

Plan Cost Click on the checkbox next to each eligible family member or choose the coverage level you would like. The cost will automatically appear in the box to the right of the members’ names. Additionally, the “Election Summary” box will be updated as coverage adjustments are made.

Total Cost While selecting plans, the cost will automatically adjust in the “Election Summary” box in response to your selections as well as your tier level.

Forms One or more of your Benefit Plans may require a paper form to be submitted with the Carrier. If this is the case,

THEbenefitsHUB will prompt you to print the necessary forms during your online enrollment session.

EVIDENCE OF INSURABILITY This page is present if you have elected coverage in excess of the Guaranteed Issue amount. For coverage to be submitted for carrier approval, please complete and submit the online Evidence of Insurability form.

Clicking the

Save and Continue button will take you to your next step.

BENEFICIARIES You will be taken to the Beneficiary Information page if you have elected benefits that require beneficiary designations.

Once you have selected your beneficiaries and completed your beneficiary designation, you will be taken to the Consolidated Enrollment Form.

Manage Beneficiaries Add button to confirm that the information is correct. Bolded fields are required. Click Save and Continue to move on and designate the You can select a dependent or a add a new beneficiary. Push the

percentage of each benefit that should go to the various beneficiaries.

Beneficiary Designation Choose what percentage of your benefits go to each beneficiary. You may not exceed a total of 100% for your primary or contingent beneficiary designation for each product. Note that some beneficiary types are ineligible for certain benefits (e.g. Spouses cannot be a primary or contingent beneficiary for Spouse Life).

CONSOLIDATED ENROLLMENT FORM If your Consolidated Enrollment Form says "Congratulations!"

This signals the end of your enrollment and the page will display information summarizing your enrollment.

You may make changes to anything that is incorrect by clicking on the Benefit Plan name to restart your enrollment.

If your Consolidated Enrollment Form says "Almost Done!"

You have completed your initial enrollment but the plan year is nearly over and you will still need to make your elections for the upcoming year. Click

Continue to go back through and make selections until you get

back to the Consolidated Enrollment Form with the "Congratulations!" messaging at the top.

When you have completed your benefit selections, click the

Menu button and you will be redirected to the

Employee Menu screen.

EMPLOYEE MENU After you have completed your enrollment in the system, you will see the following Employee Menu icons:

Personal Information You can access and edit your information by selecting the menu items under this icon.

This section will also allow you to change your Password.

Dependent Information You can access and edit information for Dependents in this section. Make sure that AssuredPartners knows of any changes made as this may change eligibility status or give an extra opportunity to change enrollment in certain benefits!

Benefit Plan Information You can access and view benefits in this section. You will not be able to change certain benefit elections unless it is during your annual enrollment period. See a quick overview of all your elected information on the Consolidated Enrollment Form. In addition to accessing the Evidence of Insurability, Beneficiary Information, and Consolidated Enrollment Form pages, you can also access the File Cabinet, which will contain enrollment snapshots of pages like the Acknowledgments and Consolidated Enrollment Form.

Company Communication You can access and view certain documents in this section including forms and email broadcasts.

NAVIGATION & INFORMATION TIPS Below are tips to help you familiarize yourself with the

THEbenefitsHUB:

Help?

If you need assistance during the enrollment process, selecting the HELP icon located at the upper right corner of the screen will help get your questions answered.

Back & Forth Please do not use your web browser’s “back” or “forward” arrows while in the system. Use the navigation buttons in the

THEbenefitsHUB instead.

Required Information As noted on each page, the field names in

bold are required to contain information before continuing to the

next page. The more information you supply the system, the better the system will work for you! But you may skip non-bolded items if they do not apply

Moving On When each election page is complete, go to the bottom of the page and select either the

Sign and

Continue button or the Save and Continue button.

Unable to Finish?

If for any reason you are unable to complete the enrollment process you may log out and log in at a later time. When you log in again, you will walk-through the same process. The information previously entered will be stored.

Need help?

Contact AspireLoyaltyProgram@AssuredPartners.com for help getting started!

ONEAMERICA RATE TABLES

ASPIRE LOYALTY REWARDS PROGRAM

Provide affordable protection from life’s unexpected events with flexible coverage options and guaranteed issue LIFE OPTION Voluntary Life with AD&D: ✓ Benefit Amount = $10,000 - $300,000 (not to exceed five times employee’s annual base salary)

✓ Guaranteed Issue = $50,000 ✓ Dependent Life Optional

DISABILITY OPTIONS Short-Term Disability: ✓ Weekly Maximum = $500 ✓ Elimination Period = 14 days ✓ Benefit Duration = 13 weeks ✓ Benefit Percentage = 60% Long-Term Disability: ✓ Monthly maximum = $ 6000 ✓ Elimination Period = 90 days ✓ Benefit Duration = 2 years to age 70 ✓ Benefit Percentage = 60%

Note: Products issued and underwritten by American United Life Insurance Company® (AUL), a OneAmerica company. Not available in all states or may vary by state.

Brought to you by Signia Aspire as an optional Bonus Benefit.

See the Aspire portal for more information to get started.

Group Name: Effective Date:

Signa 10/1/2021 Voluntary Term Life & Matching AD&D Rate Sheet:

Monthly

Benefit Maximum is limited to 5 Times EE Annual Base Salary If your Benefit Amount is: $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $110,000 $120,000 $130,000 $140,000 $150,000

0.11308 0-19 $1.10 $2.20 $3.30 $4.40 $5.50 $6.60 $7.70 $8.80 $9.90 $11.00 $12.10 $13.20 $14.30 $15.40 $16.50

20-24 $1.10 $2.20 $3.30 $4.40 $5.50 $6.60 $7.70 $8.80 $9.90 $11.00 $12.10 $13.20 $14.30 $15.40 $16.50

25 - 29 $1.10 $2.20 $3.30 $4.40 $5.50 $6.60 $7.70 $8.80 $9.90 $11.00 $12.10 $13.20 $14.30 $15.40 $16.50

Your Estimated Deduction is: 30 - 34 35 - 39 40 - 44 45 - 49 $1.30 $2.60 $3.90 $5.20 $6.50 $7.80 $9.10 $10.40 $11.70 $13.00 $14.30 $15.60 $16.90 $18.20 $19.50

$1.60 $3.20 $4.80 $6.40 $8.00 $9.60 $11.20 $12.80 $14.40 $16.00 $17.60 $19.20 $20.80 $22.40 $24.00

$2.50 $5.00 $7.50 $10.00 $12.50 $15.00 $17.50 $20.00 $22.50 $25.00 $27.50 $30.00 $32.50 $35.00 $37.50

* Monthly Premiums are based on Rates that are 'Per $1,000 of Benefit Amount'

$3.90 $7.80 $11.70 $15.60 $19.50 $23.40 $27.30 $31.20 $35.10 $39.00 $42.90 $46.80 $50.70 $54.60 $58.50

50 - 54 $5.70 $11.40 $17.10 $22.80 $28.50 $34.20 $39.90 $45.60 $51.30 $57.00 $62.70 $68.40 $74.10 $79.80 $85.50

55 - 59

60 - 64

65-69

70-74

$9.60 $19.20 $28.80 $38.40 $48.00 $57.60 $67.20 $76.80 $86.40 $96.00 $105.60 $115.20 $124.80 $134.40 $144.00

$11.80 $23.60 $35.40 $47.20 $59.00 $70.80 $82.60 $94.40 $106.20 $118.00 $129.80 $141.60 $153.40 $165.20 $177.00

$16.50 $33.00 $49.50 $66.00 $82.50 $99.00 $115.50 $132.00 $148.50 $165.00 $181.50 $198.00 $214.50 $231.00 $247.50

$38.80 $77.60 $116.40 $155.20 $194.00 $232.80 $271.60 $310.40 $349.20 $388.00 $426.80 $465.60 $504.40 $543.20 $582.00

Group Name: Effective Date: EP Option: If your Annual Salary is: $15,000 $16,000 $17,000 $18,000 $19,000 $20,000 $21,000 $22,000 $23,000 $24,000 $25,000 $26,000 $27,000 $28,000 $29,000 $30,000 $31,000 $32,000 $33,000 $34,000 $35,000 $36,000 $37,000 $38,000

Signia 10/1/2021 Short Term Disability Rate Sheet - 13 Weeks: # Lives: 2-9

2 Your Your Max Monthly Weekly Salary is: Benefit is: $1,250 $1,333 $1,417 $1,500 $1,583 $1,667 $1,750 $1,833 $1,917 $2,000 $2,083 $2,167 $2,250 $2,333 $2,417 $2,500 $2,583 $2,667 $2,750 $2,833 $2,917 $3,000 $3,083 $3,167

$173 $185 $196 $208 $219 $231 $242 $254 $265 $277 $288 $300 $312 $323 $335 $346 $358 $369 $381 $392 $404 $415 $427 $438

0.11308 0-19 $6.06 $6.46 $6.87 $7.27 $7.67 $8.08 $8.48 $8.88 $9.29 $9.69 $10.10 $10.50 $10.90 $11.31 $11.71 $12.12 $12.52 $12.92 $13.33 $13.73 $14.13 $14.54 $14.94 $15.35

20-24 $6.06 $6.46 $6.87 $7.27 $7.67 $8.08 $8.48 $8.88 $9.29 $9.69 $10.10 $10.50 $10.90 $11.31 $11.71 $12.12 $12.52 $12.92 $13.33 $13.73 $14.13 $14.54 $14.94 $15.35

Maximum Weekly Benefit:

Your Estimated Deduction is: 25 - 29 30 - 34 35 - 39 40 - 44 $6.06 $6.46 $6.87 $7.27 $7.67 $8.08 $8.48 $8.88 $9.29 $9.69 $10.10 $10.50 $10.90 $11.31 $11.71 $12.12 $12.52 $12.92 $13.33 $13.73 $14.13 $14.54 $14.94 $15.35

$5.88 $6.28 $6.67 $7.06 $7.45 $7.85 $8.24 $8.63 $9.02 $9.42 $9.81 $10.20 $10.59 $10.98 $11.38 $11.77 $12.16 $12.55 $12.95 $13.34 $13.73 $14.12 $14.52 $14.91

$4.50 $4.80 $5.10 $5.40 $5.70 $6.00 $6.30 $6.60 $6.90 $7.20 $7.50 $7.80 $8.10 $8.40 $8.70 $9.00 $9.30 $9.60 $9.90 $10.20 $10.50 $10.80 $11.10 $11.40

$4.50 $4.80 $5.10 $5.40 $5.70 $6.00 $6.30 $6.60 $6.90 $7.20 $7.50 $7.80 $8.10 $8.40 $8.70 $9.00 $9.30 $9.60 $9.90 $10.20 $10.50 $10.80 $11.10 $11.40

$500 14 Days Monthly

Elimination Period: Deductions: 45 - 49 $4.85 $5.17 $5.49 $5.82 $6.14 $6.46 $6.78 $7.11 $7.43 $7.75 $8.08 $8.40 $8.72 $9.05 $9.37 $9.69 $10.02 $10.34 $10.66 $10.98 $11.31 $11.63 $11.95 $12.28

50 - 54 $6.23 $6.65 $7.06 $7.48 $7.89 $8.31 $8.72 $9.14 $9.55 $9.97 $10.38 $10.80 $11.22 $11.63 $12.05 $12.46 $12.88 $13.29 $13.71 $14.12 $14.54 $14.95 $15.37 $15.78

55 - 59 $8.31 $8.86 $9.42 $9.97 $10.52 $11.08 $11.63 $12.18 $12.74 $13.29 $13.85 $14.40 $14.95 $15.51 $16.06 $16.62 $17.17 $17.72 $18.28 $18.83 $19.38 $19.94 $20.49 $21.05

60 - 64 $9.87 $10.52 $11.18 $11.84 $12.50 $13.15 $13.81 $14.47 $15.13 $15.78 $16.44 $17.10 $17.76 $18.42 $19.07 $19.73 $20.39 $21.05 $21.70 $22.36 $23.02 $23.68 $24.33 $24.99

65-69 $10.38 $11.08 $11.77 $12.46 $13.15 $13.85 $14.54 $15.23 $15.92 $16.62 $17.31 $18.00 $18.69 $19.38 $20.08 $20.77 $21.46 $22.15 $22.85 $23.54 $24.23 $24.92 $25.62 $26.31

70+ $11.25 $12.00 $12.75 $13.50 $14.25 $15.00 $15.75 $16.50 $17.25 $18.00 $18.75 $19.50 $20.25 $21.00 $21.75 $22.50 $23.25 $24.00 $24.75 $25.50 $26.25 $27.00 $27.75 $28.50

Group Name: Effective Date: EP Option: If your Annual Salary is: $39,000 $40,000 $41,000 $42,000 $43,000 $44,000 $45,000 $46,000 $47,000 $48,000 $49,000 $50,000 $51,000 $52,000 $53,000 $54,000 $55,000 $56,000 $57,000 $58,000 $59,000 $60,000 $61,000 $62,000

Signia 10/1/2021 Short Term Disability Rate Sheet - 13 Weeks: # Lives: 2-9

2 Your Your Max Monthly Weekly Salary is: Benefit is: $3,250 $3,333 $3,417 $3,500 $3,583 $3,667 $3,750 $3,833 $3,917 $4,000 $4,083 $4,167 $4,250 $4,333 $4,417 $4,500 $4,583 $4,667 $4,750 $4,833 $4,917 $5,000 $5,083 $5,167

$450 $462 $473 $485 $496 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500

0.11308 0-19 $15.75 $16.15 $16.56 $16.96 $17.37 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50

20-24 $15.75 $16.15 $16.56 $16.96 $17.37 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50

Maximum Weekly Benefit:

Your Estimated Deduction is: 25 - 29 30 - 34 35 - 39 40 - 44 $15.75 $16.15 $16.56 $16.96 $17.37 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50

$15.30 $15.69 $16.08 $16.48 $16.87 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00

$11.70 $12.00 $12.30 $12.60 $12.90 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00

$11.70 $12.00 $12.30 $12.60 $12.90 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00

$500 14 Days Monthly

Elimination Period: Deductions: 45 - 49 $12.60 $12.92 $13.25 $13.57 $13.89 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00

50 - 54 $16.20 $16.62 $17.03 $17.45 $17.86 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00

55 - 59 $21.60 $22.15 $22.71 $23.26 $23.82 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00

60 - 64 $25.65 $26.31 $26.97 $27.62 $28.28 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50

65-69 $27.00 $27.69 $28.38 $29.08 $29.77 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00

70+ $29.25 $30.00 $30.75 $31.50 $32.25 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50

Group Name: Effective Date: EP Option: If your Annual Salary is: $63,000 $64,000 $65,000 $66,000 $67,000 $68,000 $69,000 $70,000 $71,000 $72,000 $73,000 $74,000 $75,000 $76,000 $77,000 $78,000 $79,000 $80,000 $81,000 $82,000 $83,000 $84,000 $85,000 $86,000

Signia 10/1/2021 Short Term Disability Rate Sheet - 13 Weeks: # Lives: 2-9

2 Your Your Max Monthly Weekly Salary is: Benefit is: $5,250 $5,333 $5,417 $5,500 $5,583 $5,667 $5,750 $5,833 $5,917 $6,000 $6,083 $6,167 $6,250 $6,333 $6,417 $6,500 $6,583 $6,667 $6,750 $6,833 $6,917 $7,000 $7,083 $7,167

$500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500

0.11308 0-19 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50

20-24 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50

Maximum Weekly Benefit:

Your Estimated Deduction is: 25 - 29 30 - 34 35 - 39 40 - 44 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50

$17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00

$13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00

$13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00

$500 14 Days Monthly

Elimination Period: Deductions: 45 - 49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00

50 - 54 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00

55 - 59 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00

60 - 64 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50

65-69 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00

70+ $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50

Group Name: Effective Date: EP Option: If your Annual Salary is: $87,000 $88,000 $89,000 $90,000 $91,000 $92,000 $93,000 $94,000 $95,000 $96,000 $97,000 $98,000 $99,000 $100,000 $101,000 $102,000 $103,000 $104,000 $105,000 $106,000 $107,000 $108,000 $109,000 $110,000

Signia 10/1/2021 Short Term Disability Rate Sheet - 13 Weeks: # Lives: 2-9

2 Your Your Max Monthly Weekly Salary is: Benefit is: $7,250 $7,333 $7,417 $7,500 $7,583 $7,667 $7,750 $7,833 $7,917 $8,000 $8,083 $8,167 $8,250 $8,333 $8,417 $8,500 $8,583 $8,667 $8,750 $8,833 $8,917 $9,000 $9,083 $9,167

$500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500

0.11308 0-19 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50

20-24 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50

Maximum Weekly Benefit:

Your Estimated Deduction is: 25 - 29 30 - 34 35 - 39 40 - 44 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50

$17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00

$13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00

$13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00

$500 14 Days Monthly

Elimination Period: Deductions: 45 - 49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00

50 - 54 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00

55 - 59 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00

60 - 64 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50

65-69 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00

70+ $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50

Group Name: Effective Date: EP Option:

Signia 10/1/2021 Short Term Disability Rate Sheet - 13 Weeks: # Lives: 2-9

2

If your Annual Salary is:

Your Your Max Monthly Weekly Salary is: Benefit is:

$111,000 $112,000 $113,000 $114,000 $115,000 $116,000 $117,000 $118,000 $119,000 $120,000 $121,000 $122,000 $123,000 $124,000 $125,000 $126,000 $127,000 $128,000 $129,000 $130,000

$9,250 $9,333 $9,417 $9,500 $9,583 $9,667 $9,750 $9,833 $9,917 $10,000 $10,083 $10,167 $10,250 $10,333 $10,417 $10,500 $10,583 $10,667 $10,750 $10,833

$500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500

0.11308 0-19 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50

20-24 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50

Maximum Weekly Benefit:

Your Estimated Deduction is: 25 - 29 30 - 34 35 - 39 40 - 44 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50

$17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00

$13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00

$13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00

$500 14 Days Monthly

Elimination Period: Deductions: 45 - 49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00

50 - 54 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00

55 - 59 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00

60 - 64 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50 $28.50

65-69 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00

70+ $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50

Group Name: Effective Date: EP Option: If your Annual Salary is: $15,000 $16,000 $17,000 $18,000 $19,000 $20,000 $21,000 $22,000 $23,000 $24,000 $25,000 $26,000 $27,000 $28,000 $29,000 $30,000 $31,000 $32,000 $33,000 $34,000 $35,000 $36,000 $37,000 $38,000

Signia 10/1/2021 Long Term Disability Rate Sheet - 2 Yr Duration # Lives: 2-9

1 Your Your Max Monthly Monthly Salary is: Benefit is: $1,250 $1,333 $1,417 $1,500 $1,583 $1,667 $1,750 $1,833 $1,917 $2,000 $2,083 $2,167 $2,250 $2,333 $2,417 $2,500 $2,583 $2,667 $2,750 $2,833 $2,917 $3,000 $3,083 $3,167

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250 $1,300 $1,350 $1,400 $1,450 $1,500 $1,550 $1,600 $1,650 $1,700 $1,750 $1,800 $1,850 $1,900

0.11308 0-19 $1.13 $1.20 $1.28 $1.35 $1.43 $1.50 $1.58 $1.65 $1.73 $1.80 $1.88 $1.95 $2.03 $2.10 $2.18 $2.25 $2.33 $2.40 $2.48 $2.55 $2.63 $2.70 $2.78 $2.85

20-24 $1.13 $1.20 $1.28 $1.35 $1.43 $1.50 $1.58 $1.65 $1.73 $1.80 $1.88 $1.95 $2.03 $2.10 $2.18 $2.25 $2.33 $2.40 $2.48 $2.55 $2.63 $2.70 $2.78 $2.85

Maximum Weekly Benefit:

Your Estimated Deduction is: 25 - 29 30 - 34 35 - 39 40 - 44 $1.13 $1.20 $1.28 $1.35 $1.43 $1.50 $1.58 $1.65 $1.73 $1.80 $1.88 $1.95 $2.03 $2.10 $2.18 $2.25 $2.33 $2.40 $2.48 $2.55 $2.63 $2.70 $2.78 $2.85

$1.50 $1.60 $1.70 $1.80 $1.90 $2.00 $2.10 $2.20 $2.30 $2.40 $2.50 $2.60 $2.70 $2.80 $2.90 $3.00 $3.10 $3.20 $3.30 $3.40 $3.50 $3.60 $3.70 $3.80

$1.88 $2.00 $2.13 $2.25 $2.38 $2.50 $2.63 $2.75 $2.88 $3.00 $3.13 $3.25 $3.38 $3.50 $3.63 $3.75 $3.88 $4.00 $4.13 $4.25 $4.38 $4.50 $4.63 $4.75

$2.50 $2.67 $2.83 $3.00 $3.17 $3.33 $3.50 $3.67 $3.83 $4.00 $4.17 $4.33 $4.50 $4.67 $4.83 $5.00 $5.17 $5.33 $5.50 $5.67 $5.83 $6.00 $6.17 $6.33

$6,000 90 Day Monthly

Elimination Period: Deductions: 45 - 49 $3.63 $3.87 $4.11 $4.35 $4.59 $4.83 $5.08 $5.32 $5.56 $5.80 $6.04 $6.28 $6.53 $6.77 $7.01 $7.25 $7.49 $7.73 $7.98 $8.22 $8.46 $8.70 $8.94 $9.18

50 - 54 $5.00 $5.33 $5.67 $6.00 $6.33 $6.67 $7.00 $7.33 $7.67 $8.00 $8.33 $8.67 $9.00 $9.33 $9.67 $10.00 $10.33 $10.67 $11.00 $11.33 $11.67 $12.00 $12.33 $12.67

55 - 59 $7.63 $8.13 $8.64 $9.15 $9.66 $10.17 $10.68 $11.18 $11.69 $12.20 $12.71 $13.22 $13.73 $14.23 $14.74 $15.25 $15.76 $16.27 $16.78 $17.28 $17.79 $18.30 $18.81 $19.32

60 - 64 $14.13 $15.07 $16.01 $16.95 $17.89 $18.83 $19.78 $20.72 $21.66 $22.60 $23.54 $24.48 $25.43 $26.37 $27.31 $28.25 $29.19 $30.13 $31.08 $32.02 $32.96 $33.90 $34.84 $35.78

65-69 $14.13 $15.07 $16.01 $16.95 $17.89 $18.83 $19.78 $20.72 $21.66 $22.60 $23.54 $24.48 $25.43 $26.37 $27.31 $28.25 $29.19 $30.13 $31.08 $32.02 $32.96 $33.90 $34.84 $35.78

70+ $14.13 $15.07 $16.01 $16.95 $17.89 $18.83 $19.78 $20.72 $21.66 $22.60 $23.54 $24.48 $25.43 $26.37 $27.31 $28.25 $29.19 $30.13 $31.08 $32.02 $32.96 $33.90 $34.84 $35.78

Group Name: Effective Date: EP Option: If your Annual Salary is: $39,000 $40,000 $41,000 $42,000 $43,000 $44,000 $45,000 $46,000 $47,000 $48,000 $49,000 $50,000 $51,000 $52,000 $53,000 $54,000 $55,000 $56,000 $57,000 $58,000 $59,000 $60,000 $61,000 $62,000

Signia 10/1/2021 Long Term Disability Rate Sheet - 2 Yr Duration # Lives: 2-9

1 Your Your Max Monthly Monthly Salary is: Benefit is: $3,250 $3,333 $3,417 $3,500 $3,583 $3,667 $3,750 $3,833 $3,917 $4,000 $4,083 $4,167 $4,250 $4,333 $4,417 $4,500 $4,583 $4,667 $4,750 $4,833 $4,917 $5,000 $5,083 $5,167

$1,950 $2,000 $2,050 $2,100 $2,150 $2,200 $2,250 $2,300 $2,350 $2,400 $2,450 $2,500 $2,550 $2,600 $2,650 $2,700 $2,750 $2,800 $2,850 $2,900 $2,950 $3,000 $3,050 $3,100

0.11308 0-19 $2.93 $3.00 $3.08 $3.15 $3.23 $3.30 $3.38 $3.45 $3.53 $3.60 $3.68 $3.75 $3.83 $3.90 $3.98 $4.05 $4.13 $4.20 $4.28 $4.35 $4.43 $4.50 $4.58 $4.65

20-24 $2.93 $3.00 $3.08 $3.15 $3.23 $3.30 $3.38 $3.45 $3.53 $3.60 $3.68 $3.75 $3.83 $3.90 $3.98 $4.05 $4.13 $4.20 $4.28 $4.35 $4.43 $4.50 $4.58 $4.65

Maximum Weekly Benefit:

Your Estimated Deduction is: 25 - 29 30 - 34 35 - 39 40 - 44 $2.93 $3.00 $3.08 $3.15 $3.23 $3.30 $3.38 $3.45 $3.53 $3.60 $3.68 $3.75 $3.83 $3.90 $3.98 $4.05 $4.13 $4.20 $4.28 $4.35 $4.43 $4.50 $4.58 $4.65

$3.90 $4.00 $4.10 $4.20 $4.30 $4.40 $4.50 $4.60 $4.70 $4.80 $4.90 $5.00 $5.10 $5.20 $5.30 $5.40 $5.50 $5.60 $5.70 $5.80 $5.90 $6.00 $6.10 $6.20

$4.88 $5.00 $5.13 $5.25 $5.38 $5.50 $5.63 $5.75 $5.88 $6.00 $6.13 $6.25 $6.38 $6.50 $6.63 $6.75 $6.88 $7.00 $7.13 $7.25 $7.38 $7.50 $7.63 $7.75

$6.50 $6.67 $6.83 $7.00 $7.17 $7.33 $7.50 $7.67 $7.83 $8.00 $8.17 $8.33 $8.50 $8.67 $8.83 $9.00 $9.17 $9.33 $9.50 $9.67 $9.83 $10.00 $10.17 $10.33

$6,000 90 Day Monthly

Elimination Period: Deductions: 45 - 49 $9.43 $9.67 $9.91 $10.15 $10.39 $10.63 $10.88 $11.12 $11.36 $11.60 $11.84 $12.08 $12.33 $12.57 $12.81 $13.05 $13.29 $13.53 $13.78 $14.02 $14.26 $14.50 $14.74 $14.98

50 - 54 $13.00 $13.33 $13.67 $14.00 $14.33 $14.67 $15.00 $15.33 $15.67 $16.00 $16.33 $16.67 $17.00 $17.33 $17.67 $18.00 $18.33 $18.67 $19.00 $19.33 $19.67 $20.00 $20.33 $20.67

55 - 59 $19.83 $20.33 $20.84 $21.35 $21.86 $22.37 $22.88 $23.38 $23.89 $24.40 $24.91 $25.42 $25.93 $26.43 $26.94 $27.45 $27.96 $28.47 $28.98 $29.48 $29.99 $30.50 $31.01 $31.52

60 - 64 $36.73 $37.67 $38.61 $39.55 $40.49 $41.43 $42.38 $43.32 $44.26 $45.20 $46.14 $47.08 $48.03 $48.97 $49.91 $50.85 $51.79 $52.73 $53.68 $54.62 $55.56 $56.50 $57.44 $58.38

65-69 $36.73 $37.67 $38.61 $39.55 $40.49 $41.43 $42.38 $43.32 $44.26 $45.20 $46.14 $47.08 $48.03 $48.97 $49.91 $50.85 $51.79 $52.73 $53.68 $54.62 $55.56 $56.50 $57.44 $58.38

70+ $36.73 $37.67 $38.61 $39.55 $40.49 $41.43 $42.38 $43.32 $44.26 $45.20 $46.14 $47.08 $48.03 $48.97 $49.91 $50.85 $51.79 $52.73 $53.68 $54.62 $55.56 $56.50 $57.44 $58.38

Group Name: Effective Date: EP Option: If your Annual Salary is: $63,000 $64,000 $65,000 $66,000 $67,000 $68,000 $69,000 $70,000 $71,000 $72,000 $73,000 $74,000 $75,000 $76,000 $77,000 $78,000 $79,000 $80,000 $81,000 $82,000 $83,000 $84,000 $85,000 $86,000

Signia 10/1/2021 Long Term Disability Rate Sheet - 2 Yr Duration # Lives: 2-9

1 Your Your Max Monthly Monthly Salary is: Benefit is: $5,250 $5,333 $5,417 $5,500 $5,583 $5,667 $5,750 $5,833 $5,917 $6,000 $6,083 $6,167 $6,250 $6,333 $6,417 $6,500 $6,583 $6,667 $6,750 $6,833 $6,917 $7,000 $7,083 $7,167

$3,150 $3,200 $3,250 $3,300 $3,350 $3,400 $3,450 $3,500 $3,550 $3,600 $3,650 $3,700 $3,750 $3,800 $3,850 $3,900 $3,950 $4,000 $4,050 $4,100 $4,150 $4,200 $4,250 $4,300

0.11308 0-19 $4.73 $4.80 $4.88 $4.95 $5.03 $5.10 $5.18 $5.25 $5.33 $5.40 $5.48 $5.55 $5.63 $5.70 $5.78 $5.85 $5.93 $6.00 $6.08 $6.15 $6.23 $6.30 $6.38 $6.45

20-24 $4.73 $4.80 $4.88 $4.95 $5.03 $5.10 $5.18 $5.25 $5.33 $5.40 $5.48 $5.55 $5.63 $5.70 $5.78 $5.85 $5.93 $6.00 $6.08 $6.15 $6.23 $6.30 $6.38 $6.45

Maximum Weekly Benefit:

Your Estimated Deduction is: 25 - 29 30 - 34 35 - 39 40 - 44 $4.73 $4.80 $4.88 $4.95 $5.03 $5.10 $5.18 $5.25 $5.33 $5.40 $5.48 $5.55 $5.63 $5.70 $5.78 $5.85 $5.93 $6.00 $6.08 $6.15 $6.23 $6.30 $6.38 $6.45

$6.30 $6.40 $6.50 $6.60 $6.70 $6.80 $6.90 $7.00 $7.10 $7.20 $7.30 $7.40 $7.50 $7.60 $7.70 $7.80 $7.90 $8.00 $8.10 $8.20 $8.30 $8.40 $8.50 $8.60

$7.88 $8.00 $8.13 $8.25 $8.38 $8.50 $8.63 $8.75 $8.88 $9.00 $9.13 $9.25 $9.38 $9.50 $9.63 $9.75 $9.88 $10.00 $10.13 $10.25 $10.38 $10.50 $10.63 $10.75

$10.50 $10.67 $10.83 $11.00 $11.17 $11.33 $11.50 $11.67 $11.83 $12.00 $12.17 $12.33 $12.50 $12.67 $12.83 $13.00 $13.17 $13.33 $13.50 $13.67 $13.83 $14.00 $14.17 $14.33

$6,000 90 Day Monthly

Elimination Period: Deductions: 45 - 49 $15.23 $15.47 $15.71 $15.95 $16.19 $16.43 $16.68 $16.92 $17.16 $17.40 $17.64 $17.88 $18.13 $18.37 $18.61 $18.85 $19.09 $19.33 $19.58 $19.82 $20.06 $20.30 $20.54 $20.78

50 - 54 $21.00 $21.33 $21.67 $22.00 $22.33 $22.67 $23.00 $23.33 $23.67 $24.00 $24.33 $24.67 $25.00 $25.33 $25.67 $26.00 $26.33 $26.67 $27.00 $27.33 $27.67 $28.00 $28.33 $28.67

55 - 59 $32.03 $32.53 $33.04 $33.55 $34.06 $34.57 $35.08 $35.58 $36.09 $36.60 $37.11 $37.62 $38.13 $38.63 $39.14 $39.65 $40.16 $40.67 $41.18 $41.68 $42.19 $42.70 $43.21 $43.72

60 - 64 $59.33 $60.27 $61.21 $62.15 $63.09 $64.03 $64.98 $65.92 $66.86 $67.80 $68.74 $69.68 $70.63 $71.57 $72.51 $73.45 $74.39 $75.33 $76.28 $77.22 $78.16 $79.10 $80.04 $80.98

65-69 $59.33 $60.27 $61.21 $62.15 $63.09 $64.03 $64.98 $65.92 $66.86 $67.80 $68.74 $69.68 $70.63 $71.57 $72.51 $73.45 $74.39 $75.33 $76.28 $77.22 $78.16 $79.10 $80.04 $80.98

70+ $59.33 $60.27 $61.21 $62.15 $63.09 $64.03 $64.98 $65.92 $66.86 $67.80 $68.74 $69.68 $70.63 $71.57 $72.51 $73.45 $74.39 $75.33 $76.28 $77.22 $78.16 $79.10 $80.04 $80.98

Group Name: Effective Date: EP Option: If your Annual Salary is:

Signia 10/1/2021 Long Term Disability Rate Sheet - 2 Yr Duration # Lives: 2-9

1 Your Your Max Monthly Monthly Salary is: Benefit is:

$111,000 $9,250 $112,000 $9,333 $113,000 $9,417 $114,000 $9,500 $115,000 $9,583 $116,000 $9,667 $117,000 $9,750 $118,000 $9,833 $119,000 $9,917 $120,000 $10,000

$5,550 $5,600 $5,650 $5,700 $5,750 $5,800 $5,850 $5,900 $5,950 $6,000

0.11308 0-19 $8.33 $8.40 $8.48 $8.55 $8.63 $8.70 $8.78 $8.85 $8.93 $9.00

20-24 $8.33 $8.40 $8.48 $8.55 $8.63 $8.70 $8.78 $8.85 $8.93 $9.00

Maximum Weekly Benefit:

Your Estimated Deduction is: 25 - 29 30 - 34 35 - 39 40 - 44 $8.33 $8.40 $8.48 $8.55 $8.63 $8.70 $8.78 $8.85 $8.93 $9.00

$11.10 $11.20 $11.30 $11.40 $11.50 $11.60 $11.70 $11.80 $11.90 $12.00

$13.88 $14.00 $14.13 $14.25 $14.38 $14.50 $14.63 $14.75 $14.88 $15.00

$18.50 $18.67 $18.83 $19.00 $19.17 $19.33 $19.50 $19.67 $19.83 $20.00

$6,000 90 Day Monthly

Elimination Period: Deductions: 45 - 49 $26.83 $27.07 $27.31 $27.55 $27.79 $28.03 $28.28 $28.52 $28.76 $29.00

50 - 54 $37.00 $37.33 $37.67 $38.00 $38.33 $38.67 $39.00 $39.33 $39.67 $40.00

55 - 59 $56.43 $56.93 $57.44 $57.95 $58.46 $58.97 $59.48 $59.98 $60.49 $61.00

60 - 64

65-69

$104.53 $105.47 $106.41 $107.35 $108.29 $109.23 $110.18 $111.12 $112.06 $113.00

$104.53 $105.47 $106.41 $107.35 $108.29 $109.23 $110.18 $111.12 $112.06 $113.00

70+ $104.53 $105.47 $106.41 $107.35 $108.29 $109.23 $110.18 $111.12 $112.06 $113.00

Group Name: Effective Date:

Signa 10/1/2021 Basic Life & Matching AD&D Rate Sheet:

Monthly

Benefit Maximum is limited to 5 Times EE Annual Base Salary If your Benefit Amount is: $50,000

# of Lives: 2-9 Your Estimated Deduction is: 0-19 $5.50

20-24 $5.50

25 - 29 $5.50

30 - 34 $6.50

35 - 39 $8.00

40 - 44 $12.50

* Monthly Premiums are based on Rates that are 'Per $1,000 of Benefit Amount'

45 - 49 $19.50

50 - 54 $28.50

55 - 59 $48.00

60 - 64 $59.00

65-69 $82.50

70-74 $194.00