Long Term Disability Summary Plan Description

SECTION 1 - SCHEDULE OF BENEFITS (Continued)

LONG TERM DISABILITY COVERAGE

What is the Elimination Period? The greater of:

a. the end of your Short Term Disability Benefits; or b. 180 days

What is the Amount of Insurance Benefits? 60.00% of Basic Monthly Earnings not to exceed a Maximum Monthly Benefit of $10,000.00 less Other Income Benefits and Other Income Earnings as outlined in Section 4.

$16,666.67

What is the Maximum Basic Monthly Earnings on which the Benefit is Based?

What is the Own Occupation Duration? 24 Month Own Occupation

ADOC-SCH-3

Schedule of Benefits

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