SCHEDULE OF BENEFITS (continued) Accidental Death and Dismemberment Insurance (AD&D) For You: Basic AD&D Basic Accidental Death and Dismemberment Insurance for You is NOT Portability Eligible Insurance Full Amount For Basic AD&D ......................................... $5,000 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 Basic 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 permanentl y 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 fin ger 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. Loss of hearing means the entire and irrecoverable loss of hearing in both ears that continues for 6 consecutive months following the accidental injury. GCERT2024-WSHCA-WA-LIFE-EMPLOYEE1 31