Accident – Explore Your Benefits Flyer 2024

Accident Insurance Explore Your Benefits & Costs Group Name: UnityPoint Health Group Number: 688941 Cleaning the gutters. Yoga class. Soccer practice. Life offers plenty of opportunities for accidental injuries. When an injury happens, Accident Insurance can help. This document includes expanded cost and benefit information for Accident Insurance. As you explore, keep in mind: No medical questions or tests Employees get an annual Benefit payments go directly to are required for Accident Wellness Benefit of $50 for you. Use them how you’d like! coverage. completing an eligible health screening test. Accident Insurance doesn’t replace your medical coverage; instead, it complements it. The benefit payments don’t go out to pay for medical bills or treatments you may need, instead they come in—directly to you— to be used however you’d like. Choose this supplemental health insurance product for added protection if one of the following covered conditions comes your way. Accident Insurance is a limited benefit policy. It is not health insurance, and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. ReliaStar Life Insurance Company ® a member of the Voya family of companies

How much does it cost? This table shows your rates for Accident Insurance. The cost provided below includes Accident Insurance premium and a fee for Voya Travel Assistance. Bi-Weekly Rates (26 Pay Periods) Employee Employee and Employee and Family Spouse Children $4.69 $7.70 $8.91 $11.92 Your spouse will be covered for the same Accident benefits as you. If you have coverage on yourself, your natural children, stepchildren, adopted children or children for whom you are legal guardian can be covered up to age 26. Your children will be covered for the same benefit amounts as you. One premium amount covers all of your eligible children. What’s covered? Accident Insurance provides a benefit payment after a covered accident that results in the specific injuries and treatments listed in this document. This plan covers you 24 hours a day. Some of the most common treatments and conditions we pay benefits for include: ER treatment X-rays Physical therapy Stitches Follow-up doctor treatment(s) Sample payment amounts If one of these events happens to you, and your claim is approved, you’d receive a benefit payment in the amount listed below. Use it however you’d like: Accident-related treatment Benefit Emergency room treatment $250 X-ray $90 Physical or occupational therapy (up to six per accident) $60 Stitches (for lacerations, up to 2”) $90 Follow-up doctor treatment $100 Hospital admission $1,500 Hospital confinement (per day, up to 365 days) $375 This is only a small preview of the benefits available to you. See the full Schedule of Benefits toward the end of this document.

For a list of standard exclusions and limitations, please refer to the end of this document. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any riders. What else is included? The Accident Insurance available through your employer includes the following additional benefits: Receive $50 Wellness Benefit Complete an eligible health screening test, and we’ll send you a benefit to use payment to use however you’d like. however  Employees receive an annual benefit payment of $50. you’d like  Spouses receive an annual benefit payment of $50.  Children receive $50 per child - with no child limit . Additional non-insurance service(s) Voya Travel Assistance When traveling more than 100 miles from home, Voya Travel Assistance Access extra offers enhanced security for your leisure and business trips. You and your support next time dependents can take advantage of four types of services: pre-trip information, you travel emergency personal services, medical assistance services and emergency transportation services. Voya Travel Assistance services are provided by Europ Assistance USA, Bethesda, MD. Schedule of Benefits The following list is a summary of the benefits provided by Accident Insurance. You may be required to seek care for your injury within a set amount of time. Note that there may be some variations by state. For a list of standard exclusions and limitations, go to the end of this document.  Your coverage includes a Health System Benefit. This means that if the services for your covered accident are provided at a facility that is owned by your employer/organization, the benefit amounts listed in the accident hospital care, accident care or common injuries sections below will be increased by 25%; to a maximum additional benefit of $1,000. Event Benefit Accident hospital care Surgery open abdominal, thoracic $1,500 Surgery exploratory or without repair $200 Blood, plasma, platelets $625 Hospital admission $1,500 Hospital confinement per day, up to 365 days $375 Critical care unit confinement per day, up to 15 days $600

Rehabilitation facility confinement per day, up to 90 days $200 Non-Induced Coma (duration of 14 or more days) $18,500 Induced Coma (duration of 14 or more days) $200 Transportation per trip, up to three per accident $800 Lodging per day, up to 30 days $200 Family care per child per day, up to 45 days $30 Event Benefit Accident care Initial doctor visit $100 Urgent care facility treatment $250 Emergency room treatment $250 Ground ambulance $400 Air ambulance $2,000 Follow-up doctor treatment $100 Chiropractic treatment up to six per accident $60 Medical equipment $275 Physical or occupational therapy up to six per accident $60 Speech therapy up to 6 per accident $60 Mental Health Therapy (up to 10 per accident) $60 Prosthetic device (one) $1,250 Prosthetic device (two or more) $2,000 Outpatient surgery (one per accident) $250 X-ray $90 Common injuries Burns second degree, at least 36% of the body $1,500 Burns third degree, at least nine but less than 35 square inches of the $8,500 body Burns third degree, 35 or more square inches of the body $20,000 Skin grafts 50% of the burn benefit Emergency dental work $400 crown, $125 extraction Eye injury removal of foreign object $110 Eye injury surgery $400 Torn knee cartilage surgery with no repair or if cartilage is shaved $250 Torn knee cartilage surgical repair $900 1 Laceration treated no sutures $50 1 Laceration sutures up to 2” $90 1 Laceration sutures 2” – 6” $350 1 Laceration sutures over 6” $750 Puncture Wound $50 Ruptured disk surgical repair $900 Tendon/ligament/rotator cuff $600 exploratory arthroscopic surgery with no repair Tendon/ligament/rotator cuff one, surgical repair $925

Tendon/ligament/rotator cuff two or more, surgical repair $1,400 Concussion $275 Paralysis - monoplegia $12,500 Paralysis - hemiplegia $17,500 Paralysis - paraplegia $18,000 Paralysis - quadriplegia $27,000 Event Benefit Non-surgical/ 2 Dislocations surgical repair Hip joint $5,000/$10,000 Knee $3,000/$6,000 Ankle or foot bone(s) $1,800/$3,600 other than toes Shoulder $2,200/$4,400 Elbow $1,500/$3,000 Wrist $1,500/$3,000 Finger/toe $350/$700 Hand bone(s) other than fingers $1,500/$3,000 Lower jaw $1,500/$3,000 Collarbone $1,500/$3,000 Partial dislocations 25% of the non-surgical repair amount Non-surgical/ 3 Fractures surgical repair Hip $6,000/$12,000 Leg $2,800/$5,600 Ankle $2,500/$5,000 Kneecap $2,500/$5,000 Foot excluding toes, heel $2,500/$5,000 Upper arm $2,750/$5,500 Forearm, hand, wrist except fingers $2,500/$5,000 Finger, toe $400/$800 Vertebral body $4,200/$8,400 Vertebral processes $2,000/$4,000 Pelvis except coccyx $4,000/$8,000 Coccyx $500/$1,000 Bones of face except nose $1,400/$2,800 Nose $750/$1,500 Upper jaw $1,750/$3,500 Lower jaw $2,000/$4,000 Collarbone $2,000/$4,000 Rib or ribs $600/$1,200 Skull – simple except bones of face $1,750/$3,500 Skull – depressed except bones of face $5,000/$10,000 Sternum $500/$1,000

Shoulder blade $2,500/$5,000 Chip fractures 25% of the non-surgical reduction amount 1 Laceration benefits are a total of all lacerations per accident. 2 Non-surgical repair of a completely separated joint may be referred to in your policy documentation as a “closed reduction.” Surgical repair of a completely separated joint may be referred to in your policy documentation as an “open reduction.” 3 Non-surgical repair of a fracture may be referred to in your policy documentation as a “closed reduction.” Surgical repair of a fracture may be referred to in your policy documentation as an “open reduction.” Accidental Death & Dismemberment Your coverage also includes Accidental Death & Dismemberment benefits. This means that if you are severely injured or pass away due to an accident, additional benefits may apply. See the chart below for more details. A “common carrier” is commercial transportation that operates on a regular schedule, between predetermined points or cities (such as a bus or airline route). Accidental Death Benefits Benefit Common carrier accident Employee $100,000 Spouse $50,000 Children $25,000 Other accident Employee $50,000 Spouse $20,000 Children $10,000 Accidental Dismemberment Benefits Loss of both hand or both feet or sight in both eyes $28,000 Loss of one hand or one foot AND the sight of one eye $22,000 Loss of one hand AND one foot $22,000 Loss of one hand OR one foot $12,500 Loss of two or more fingers or toes $1,800 Loss of one finger or one toe $1,250

Ready to Enroll? Enrollment instructions will be provided by your employer. If you have additional questions before you enroll, please call: Voya Employee Benefits Customer Service at (877) 236-7564 or go to https://presents.voya.com/EBRC/UnityPointHealth Exclusions and limitations Standard exclusions for the Certificate, Spouse Accident Insurance, and Children’s Accident Insurance and AD&D are listed below. (These may vary by state.) For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any riders. Benefits are not payable for any loss caused in whole or directly by any of the following*:  Participation or attempt to participate in a felony or illegal activity.  An accident while the covered person is operating a motorized vehicle while intoxicated. Intoxication means the covered person’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred.  Suicide, attempted suicide or any intentionally self-inflicted injury, while sane or insane.  War or any act of war, whether declared or undeclared, other than acts of terrorism.  Loss sustained while on active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.  Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor.  Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.  Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded. Performing these acts as part of your employment with the employer is not excluded.  Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities.  Practicing for, or participating in, any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received.  Any sickness or declining process caused by a sickness.  Work for pay, profit or gain. This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. To keep coverage in force, premiums are payable up to the date of coverage termination. Accident Insurance is underwritten by ReliaStar Life Insurance Company (Minneapolis, MN), a member of the Voya® family of companies. Policy Form #RL-ACC3-POL-16; Certificate Form #RL-ACC3-CERT-16; and Rider Forms: Spouse Accident Rider Form #RL-ACC3-SPR-16, Children's Accident Rider Form #RL-ACC3-CHR-16, Wellness Benefit Rider Form #RL-ACC3-WELL-16, Accidental Death & Dismemberment (AD&D) Rider Form #RL-ACC3-ADR-16. Form numbers, provisions and availability may vary by state and employer’s plan. 1222304 ACC2 Only Date Prepared 08/24/2023 212309-08152020