SCHEDULE OF BENEFITS (continued) Plan 2: Supplemental Accidental Death and Dismemberment Insurance for You is NOT Portability Eligible Insurance Plan 2: All employees of an Employing Agency who did not elect Employee-Paid Life Insurance An amount You previously elected coverage in a multiple of $10,000 for coverage on or under Your Employing Agency’s after January 1, 2017. These employees retained previous life insurance plan which coverage amounts elected prior to January 1, 2017 doesn’t match the MetLife plan that were not in a multiple of $10,000 ........................... design Additional Benefits: Seat Belt Benefit ............................................................ Yes Air Bag Use Benefit ........................................................ Yes Child Care Benefit .......................................................... Yes Child Education Benefit .................................................. Yes Spouse or State-Registered Domestic Partner Education Benefit ........................................................... Yes Hospital Confinement Benefit ......................................... Yes Common Carrier Benefit ................................................ Yes The Common Carrier Benefit is an amount equal to the Full Amount. Schedule of Covered Losses for Supplemental Accidental Death and Dismemberment Insurance All amounts listed are stated as percentages of the Full Amount. Covered Losses Loss of life .................................................................................... 100% Loss of a hand permanently severed at or above the wrist but below the elbow ....................................................... 50% Loss of a foot permanently severed at or above the ankle but below the knee ....................................................... 50% Loss of an arm permanently severed at or above the elbow ....... 50% Loss of a leg permanently severed at or above the knee ............ 50% Loss of sight in one eye ............................................................... 50% Loss of sight means permanent and uncorrectable loss of sight in the eye. Visual acuity must be 20/200 or worse in the eye or the field of vision must be less than 20 degrees. Loss of any combination of hand, foot, or sight of one eye, as defined above .............................................................................. 100% Loss of the thumb and index finger of same hand ....................... 25% Loss of thumb and index finger of same hand means that the thumb and index finger are permanently severed through or above the third joint from the tip of the index finger and the second joint from the tip of the thumb. Loss of speech and loss of hearing ............................................. 100% Loss of speech or loss of hearing ................................................ 50% Loss of speech means the entire and irrecoverable loss of speech that continues for 6 consecutive months following the accidental injury. GCERT2024-WSHCA-WA-LIFE-EMPLOYEE1 33