Blue Mantis Short-Term Disability

Short-Term Disability Insurance We’ve Got You Covered As an active employee of Blue Mantis, you have access to a disability income insurance policy from United of Omaha Life Insurance Company. A disability income insurance policy can help provide security when you need it, plus give you peace of mind so you can recover faster and get back on the job sooner. Coverage guidelines and benefits are outlined below. ELIGIBILITY - ALL ELIGIBLE EMPLOYEES Eligibility You must be actively working a minimum of 30 hours per week to be eligible for Requirement coverage. Premium The premiums for this insurance are paid in full by the policyholder. There is no cost to Payment you for this insurance. BENEFITS Elimination If you become disabled, there is an elimination period before benefits are payable. Your Period benefits begin: ·On the day of your disabling injury. ·On the 8th day of your disabling illness. Weekly Benefit Your benefit is equivalent to 60% of your before-tax weekly earnings, not to exceed the plan’s maximum weekly benefit amount less other income sources. Maximum Benefit Up to 13 weeks Period Maximum Weekly $1,500 Benefit Minimum Weekly None Benefit 44910 G000BYZS

Partial Disability If you become disabled and can work part-time (but not full-time), you may be eligible Benefits for partial disability benefits, which will help supplement your income until you are able to return to work full-time. DEFINITIONS Definition of Disability and disabled mean that because of an injury or illness, a significant change in Disability your mental or functional abilities has occurred, for which you are prevented from performing at least one of the material duties of your regular job and are unable to generate current earnings which exceed 99% of your weekly earnings from your regular job. You can be totally or partially disabled during the elimination period. Definition of Weekly earnings for salaried employees is the gross annual salary in effect immediately Weekly Earnings prior to the date disability begins, divided by 52. Weekly earnings for hourly employees is the hourly rate of pay multiplied by the average number of hours worked per week during the 12 month period immediately prior to the date disability begins. If employed for part of the prior 12 month period, weekly earnings is the hourly rate of pay multiplied by the average number of hours worked. FEATURES Voluntary If you become disabled and choose to participate in the vocational rehabilitation Vocational program, you will be eligible for a monthly benefit increase of 10%. Rehabilitation Benefit SERVICES Hearing Discount The Hearing Discount Program provides you and your family discounted hearing Program products, including hearing aids and batteries. Call 1-888-534-1747 or visit www.amplifonusa.com/mutualofomaha to learn more.

Who is eligible for this insurance? You must be actively working (performing all normal duties of your job) at least 30 hours per week. How long will my benefits be paid? Benefits begin after the end of the elimination period and can be payable up to the maximum benefit period as long as you remain disabled. Will my benefits be reduced by other sources of income? Yes, depending on the type of income you receive. Your benefit amount may be reduced by other sources of income such as retirement/government plans, other group disability plans, paid family leave, salary continuance/sick leave, settlements on payments received and no-fault benefits. Does this plan cover me if I become disabled due to an injury at work? No, your STD insurance only provides benefits for off-the-job coverage for disabilities due to injury or sickness. Are there any limitations or exclusions? The benefits payable are subject to the following: · A pre-existing condition limitation does not apply. · Benefits are not payable for any disability or loss that: - Results from an act of declared or undeclared war or armed aggression - Results from participation in a riot or commission of or attempt to commit a felony - Arises out of or in the course of employment with the policyholder for benefits under any workers’ compensation or occupational disease law, or receives any settlement from the workers’ compensation carrier - Results, whether the insured person is sane or insane, from an intentionally self-inflicted injury or illness, suicide, or attempted suicide - Occurs while incarcerated or imprisoned for any period exceeding 31 days - Is solely a result of a loss of a professional license, occupation license or certification All exclusions may not be applicable, or may be adjusted, as required by state regulations. This information describes some of the features of the benefits plan. Benefits may not be available in all states. Please refer to the certificate booklet for a full explanation of the plan’s benefits, exclusions, limitations and reductions. Should there be any discrepancy between the certificate booklet and this summary, the certificate booklet will prevail. Benefits availability is subject to final acceptance and approval of the group application by the underwriting company. Disability income insurance is underwritten by United of Omaha Life Insurance Company, 3300 Mutual of Omaha Plaza, Omaha, NE 68175, 1-800-769-7159. United of Omaha Life Insurance Company is licensed nationwide, except in New York. Policy form number 7000GM-U-EZ-2010. SHORT-TERM DISABILITY INSURANCE