IC-2574-254-0797

WEA Trust

Long Term Disability Plan

A WEA Insurance CorporationGroup Long Term Disability Policy

45 Nob Hill Road (53713-3959)P.O. Box 7338 (53707-7338)

Madison, WisconsinVoice/TDD:

608-276-40001-800-279-4000

Copyright © 2000 WEA Insurance Corporation

All rights reserved. No part of this policy and certificate, including addenda, amendments, andappendices, may be reproduced or copied in any form or by any means—graphic, electronic, ormechanical—without written permission of the WEA Insurance Corporation, except as required toinquire about or appeal the entitlement to benefits hereunder.

Problems with your insurance?

If you are having problems with WEA Insurance Corporation, do not hesitate to call or writeWEA Insurance to resolve your problem. The address and phone numbers are:

WEA Insurance CorporationP.O. Box 7338

Madison, WI 53707-7338Voice/TDD: 1-800-279-4000 or 608-276-4000

You may also write the OFFICE OF THE COMMISSIONER OF INSURANCE, a stateagency that enforces Wisconsin’s insurance laws, and file a complaint. The address is:

Office of the Commissioner of InsuranceComplaints Department

P.O. Box 7873Madison, WI 53707-7873

Or, you may call 1-800-236-8517 outside of Madison or 266-0103 in Madison, and request acomplaint form.

IC-2574-254-0797

Important Notice(Keep this notice with your insurance papers)

This is an indemnity insurance policy. It obligates the Company to replace a percentage of theincome lost by a Covered Employee when he or she cannot work due to Disability. Initialeligibility for a Benefit under this policy requires that a Covered Employee be unable toperform adequately the material and substantial duties of his or her Regular Occupation due toinvoluntary and medically proven physical or mental impairment(s). Income that a beneficiaryearns by working and certain other benefits for which the beneficiary is eligible because of hisor her Disability will reduce the Benefit payable under this policy.

IC-2574-254-0797

Group Long Term DisabilityPolicy and Certificate

WEA Insurance Corporation

The WEA Insurance Corporation (herein called the Company) does hereby agree to provide benefitsin accordance with all of the provisions, exclusions, and limitations of this policy.

IN WITNESS WHEREOF, the WEA Insurance Corporation, by its President and Vice President,has executed and attested this policy.

WEA Insurance Corporation WEA Insurance CorporationMadison, Wisconsin Madison, Wisconsin

President, Vice President,

Table of ContentsArticle I – Employer’s Policy Provisions: Rights and Obligations

of the Company and the Policyholder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Participation Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Premium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1When Premiums Are Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Grace Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Termination of the Policy by the Policyholder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Retroactive Salary Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Waiver of Premium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Termination of the Policy by the Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Information Required From the Policyholder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Clerical Error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Incontestability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Statements by Employees or Agents of the Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Entire Contract and Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Conformity With State Statutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Article II – Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Article III – Eligibility and Dates of Coverage . . . . . . . . . . . . . . . . . . . . . . . . 6Individuals Eligible for Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Effective Date of Coverage for Employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Effective Date of Coverage for Disabled Persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Effective Date of Coverage for Persons on Unpaid Leave of Absence . . . . . . . . . . . . . . . . . . 7Coverage During Unpaid Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Late Application for Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Coverage Termination Dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Suspension of Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Article IV – Qualification for Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Qualification for Benefits During the First 24 Months of Disability . . . . . . . . . . . . . . . . . . . 9Satisfying the Elimination Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Qualification for Benefits After 24 Months of Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Change in Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Article V – Claims Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Notice of Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Proof of Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Continuing Proof of Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13“Involuntary” Loss of Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Article VI – Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Gross Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Net Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Reduction in Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Benefits During Rehabilitation and Retraining . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Integration of Other Income Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Other Income Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Types of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Lump Sum Award of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Income Not Subject to Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Appeal of a Denial of Other Income Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

IC-2574-254-0797

Benefit Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Contract Day Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Monthly Method – Annualization of Salary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Cost of Living Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Benefit Termination Dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Company’s Right of Recoupment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Article VII – Exclusions and Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Article VIII – Responsibilities of a Disabled Covered Employee . . . . . . . . 21Duty to Make Efforts to Recover and Otherwise Mitigate Losses . . . . . . . . . . . . . . . . . . . . 21Duty to Furnish Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Company’s Right to Examine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Covered Employee’s Failure to Comply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Article IX – Subrogation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Article X – Appeal Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Rights of the Covered Employee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Legal Actions by the Covered Employee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Amendments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Minimum Benefit: 25% of Gross Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Minimum Benefit: $50.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Minimum Benefit: $100.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40WEA Cost of Living Adjustment Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41CPI-U Cost of Living Adjustment Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

IC-2574-254-0797

Participation RequirementsThis policy will be effective on the datespecified on the Employer’s Application forGroup Insurance, provided that thefollowing participation requirements are met.If the Employer does not maintain compliancewith these participation requirements, theCompany may terminate the policy.

1. Seventy-five percent (75%) of theEmployees eligible for coverage under aContributory Policy are actually coveredby the policy;

2. One hundred percent (100%) of theEmployees eligible for coverage under aNoncontributory Policy are actuallycovered by the policy;

3. The Employer and a bargaining agentaffiliated with the Wisconsin EducationAssociation Council have negotiated theinsurance coverage provided by this policy;

4. The Employer’s plan which provides theBenefits of this policy satisfies thenondiscrimination requirements in effectunder sections 501(c)(9) and 505(b) of theInternal Revenue Code; and

5. The Employer meets the contributionrequirements established by the Companyfor this policy. If the Company insuresninety percent (90%) of Covered Salary,then the Employer must contribute onehundred percent (100%) of the premium sothat the policy is a Noncontributory Policy.

An employee is eligible for coverage under thispolicy only if his or her job and number ofhours of regular employment meet the criteriaof the Eligible Class specified by the Employeron the Application for Group Insurance.

PremiumThe monthly premium required for eachEmployee covered by this policy for any partof that month is the product of the rateshown on the Rate Summary and theEmployee’s Covered Salary. The monthlypremium required by this policy is the sum ofthe premiums for all Covered Employees. Thepremium will always be based on the ratesfor the Benefits which are in effect on thedate that the premium is due. The Companymay establish a new rate for any or all of theBenefits provided under this policy on any ofthe following dates:

1. Any policy anniversary date, providedthat the Company notifies the Employer atleast thirty-one (31) days prior to that date;

2. Any date premium is due, provided thatthe rate(s) being changed have been ineffect for at least twelve (12) months priorto the change and the Company notifiesthe Employer at least thirty-one (31) daysprior to that date; and

3. Any date on which any provision of thispolicy is materially changed by agreementbetween the Employer and the Company orby statute.

The Company will not increase premiumrates by twenty-five percent (25%) or morewithout sixty (60) days’ notice to theEmployer.

IC-2574-254-0797 1

Article IEmployer’s Policy Provisions: Rights and Obligationsof the Company and the Policyholder

Premium is due for a Covered Employee foreach month in which he or she is coveredunder this policy for at least one day, exceptthat if an Employee’s initial coverage beginsafter the fifteenth (15th) day of the month,the premium liability for that Employee willcommence on the first day of the monthfollowing the date of his or her coverage.

The Employer will notify the Companyimmediately whenever a Covered Employeeceases to be eligible for coverage. Thepremium liability for that Employee willcease on the last day of the month in whichthe coverage terminates.

The payment of premium per se will notobligate the Company to provide Benefits toan individual who is not eligible for coverageby this policy.

When Premiums Are DueThe monthly premium required by this policyis due and payable by the Employer to theCompany on or before the twentieth (20th)day of the month preceding the month ofcoverage.

Grace PeriodThe Company will allow a grace period ofthirty-one (31) days for the receipt of anypremium due after the first premium. Duringthe grace period this policy will continue inforce. The grace period will start with thefirst day of the month following the day thepremium is due. There will be no grace periodif the Employer or the Company has givenwritten notice of termination to the otherparty as provided herein.

Termination of the Policy bythe PolicyholderThe Employer may terminate this policy onthe first day of any month by giving writtennotice of termination to the Company at leastthirty-one (31) days prior to that date. If theEmployer does not pay the premium whendue or within the grace period, this policy willterminate at the expiration of the graceperiod. The Employer is liable to the

Company for the payment of all premiumsdue and unpaid, including the premium forcoverage during the grace period, as well asthe costs and reasonable legal fees incurredby the Company in collecting the premiumsowed.

In the event that the Company agrees towaive the automatic termination of this policycaused by the nonpayment of premium, theCompany may charge interest on thedelinquent premium and the Employer willpay that interest. The interest rate applicableto a month in which interest is charged willbe the prime interest rate published in TheWall Street Journal on the first business dayof that month plus one percent (1%).

Retroactive SalaryAdjustmentsWhen, as the result of collective bargaining orthe Employer’s decision, the Annual Salariesof Employees in the Eligible Class specifiedon the Employer’s Application for GroupInsurance or an identifiable group of thoseEmployees are retroactively adjusted, theCovered Salaries will be retroactivelyadjusted for all affected Employees in theEligible Class or identifiable group. TheEmployer will pay the additional premiumrequired by the increase in Covered Salariesretroactive to the effective date of the salaryadjustments.

Waiver of PremiumThe Company will waive the premiumrequired for a Covered Employee aftersatisfaction of the Elimination Period.

Termination of the Policy bythe CompanyIf the Employer does not comply with all ofthe Participation Requirements and premiumobligations specified above, the Company mayterminate this policy by giving written noticeto the Employer at least thirty-one (31) daysprior to the termination date.

In addition, the Company may terminate thispolicy for any legally permissible reason on

2 IC-2574-254-0797

any policy anniversary date by giving writtennotice to the Employer at least sixty (60) daysprior to that date.

Information Required Fromthe PolicyholderThe Employer will furnish to the Companyany information which the Company mayrequire for the administration of this policy.The Company may inspect, at any reasonabletime, any records of the Employer which arerelevant to the administration of this policy.

Clerical ErrorThe Employer’s failure, due to clerical error,to report the name of an Employee who iseligible for coverage under this policy will notdeprive that person of coverage or affect theBenefits to which he or she is entitled,provided that the correct enrollmentinformation is furnished to the Company nolater than six (6) months after the date theEmployee became eligible for coverage. Therewill be no retroactive coverage by this policyto correct a clerical error unless that clericalerror is reported to the Company within six(6) months after its occurrence.

If the Employer erroneously pays premium ona salary which is less than the CoveredEmployee’s actual Covered Salary, theEmployer will correct that error by paying therequired additional premium. Further, theerror will be corrected retroactively to itsorigin and all like errors must be corrected forall Covered Employees in the Eligible Class.

The Employer’s failure to report thetermination of coverage for any person will notcontinue that coverage beyond the appropriatedate of termination as defined by this policy.

An Employer’s error will not create anyliability whatsoever for the Company.

IncontestabilityNo statement made by an Employee, except afraudulent misstatement, will be used tocontest the validity of the Employee’scoverage under this policy after that coveragehas been in effect for two (2) years.

Statements by Employeesor Agents of the CompanyNo statement or representation by anyemployee or agent of the Company can alteror waive any of the requirements orprovisions of this policy, and no statement orrepresentation with respect to theinterpretation or application of any provisionof this policy is binding on the Companyunless it is issued by an officer in writing onbehalf of the Company.

Entire Contract andChangesThe entire contract of insurance consists of:

1. This policy and any amendments;

2. The Benefit Summary;

3. The Rate Summary;

4. The Application for Group Insurance;

5. The Employees’ enrollment applications;

6. The evidence of insurability formssubmitted by Employees; and

7. Reimbursement Agreements signed byCovered Employees who receive Benefits.

No change in this policy will be valid unlesswritten and signed by an officer of theCompany. No agent may change the policy orwaive any of its provisions.

Conformity With StateStatutesAny provision of this policy which conflictswith the statutes of the state in which thepolicy is issued is hereby amended to conformto the minimum requirements of thosestatutes. The effective date of any suchrequired amendment will be the latest datepermitted by those statutes.

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These defined terms appear throughout thispolicy. As a general rule, terms which arecapitalized in the text of the policy are includedin this list of defined terms. Capitalized termswhich are not in this list refer to items on theBenefit Summary or on the Employer’sApplication for Group Insurance or are definedin the article in which they are used.

Annual Salary means “the totalcompensation, exclusive of bonuses andovertime, to be earned by the CoveredEmployee in exchange for the performance ofa normal year of services to the Employer atthe current rate of pay.” If you becomeDisabled during the period between schoolyears, and you do not regularly work duringthose months, your Annual Salary is thatwhich you were receiving at the end of thepreceding school year.

Company means “the WEA InsuranceCorporation.”

Contributory Policy means “a policy forwhich the Covered Employee reimburses thepolicyholder a portion of the premiumrequired by the policy.”

Covered Employee means “an Employeemeeting the eligibility requirements of thispolicy, including any required evidence ofinsurability, whose written application forcoverage has been approved by the Companyand for whom premium has been received.”

Covered Loss means “that portion of theCovered Salary which would have beenearned by the Covered Employee after the

Elimination Period if he or she were notDisabled, but which has been lost and nototherwise replaced.”

Covered Salary means “the Annual Salaryof the Covered Employee that has been mostrecently declared by the Employer for thepurpose of premium computations before theDate of Disability.” In no event will theCovered Salary on which Benefits are basedexceed the Annual Salary on which premiumshave been paid.

Date of Disability means “the date whichthe Company determines to be the first day onwhich the Covered Employee was Disabled.”

Disabled and Disability mean “the inabilityof a Covered Employee to perform adequatelythe material and substantial duties of his orher Regular Occupation due to his or her owninvoluntary and medically proven anddocumented physical or mental impairment(s).”

Elimination Period means “the period ofcalendar days for which no Benefits will bepaid under this policy to a Covered Employeewho has been found by the Company to beDisabled.” The length of the EliminationPeriod is specified on the Benefit Summaryand begins on the Date of Disability.

Employee means “an individual who isengaged in active, regular performance of jobduties for, and is earning wages from, theEmployer and whose job and number of hoursof regular employment meet the criteria forinclusion in the Eligible Class specified on theEmployer’s Application for Group Insurance.”

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Article IIDefinitions

Whenever the words “you” or “your” appear in this policy, they refer to a Covered Employeeas defined in Article II; and whenever the words “we,” “us,” or “our” appear, they refer to theCompany as defined in Article II.

Employer means “the employer identified onthe Application for Group Insurance and onthe Benefit Summary.”

Gross Benefit means “the monthly Benefitamount calculated as a percentage of CoveredSalary before any reduction for Other IncomeBenefits and earnings during a Period ofDisability.”

Monthly Covered Salary means “theCovered Employee’s Covered Salary dividedby twelve (12).”

Net Benefit means “the monthly amount dueunder this policy as a partial replacement of aCovered Loss.”

Noncontributory Policy means “a policyfor which the Employer pays one hundredpercent (100%) of the required premium.”

Period of Disability means “one continuousperiod of Disability beginning on the CoveredEmployee’s Date of Disability, including theElimination Period, and ending on the dateon which the Covered Employee dies orceases to be Disabled or Totally Disabled.”

Once the Elimination Period has beensatisfied, successive periods of Disability orTotal Disability will be deemed to be thesame Period of Disability unless

• Due to an unrelated cause and separatedby a return to the regular performance ofduties for the Employer or

• Due to the same or related cause butseparated by a return to the regularperformance of duties for the Employer forsix (6) months.

Physician means “a qualified practitionerother than the Covered Employee or amember of his or her immediate family (i.e., spouse, parent, sibling, or child) who islicensed to diagnose and treat the physical ormental impairment(s) causing the CoveredEmployee’s Disability.” This definitionincludes only the following practitioners, andonly to the extent that the services providedare within the scope of the individualpractitioner’s professional license:

• M.D. – Doctor of Medicine

• D.O. – Doctor of Osteopathy

• D.S.C. – Doctor of Surgical Chiropody

• D.P.M. – Doctor of Podiatric Medicine

• O.D. – Doctor of Optometry

• D.C. – Doctor of Chiropractic

• D.D.S. – Doctor of Dental Surgery

• D.M.D. – Doctor of Medical Dentistry

Regular Care of a Physician means “theCovered Employee is being seen by a Physicianat intervals of time appropriate for treating thedisabling impairment(s); the CoveredEmployee’s Physician is rendering and/orprescribing a pertinent treatment plan or apractical protocol, if one exists, for alleviatingor eliminating the impairment(s) causing theDisability or Total Disability; and the CoveredEmployee is complying with all aspects of thePhysician-prescribed treatment plan.”

Regular Occupation means “the positionheld by the Covered Employee with theEmployer on the Covered Employee’s Date ofDisability.”

Substantial Gainful Activity means“activity of a nature generally performed aswork for remuneration or profit, involving theperformance of significant physical or mentalduties, or a combination of the two.” Workwill be considered substantial even if it isperformed part-time, and even if it is lessdemanding and less responsible than yourformer work; and it will be considered gainfuleven if it pays less than your former work.

Totally Disabled and Total Disabilitymean “a disability which meets the criterionestablished by the Social Security Act for thereceipt of Social Security Disability Insurancebenefits, which criterion is the inability toengage in any Substantial Gainful Activity byreason of any medically determinable physicalor mental impairment which can be expectedto result in death or which has lasted or canbe expected to last for a continuous period ofnot less than twelve (12) months.”

Waiting Period means “the period of timean Employee must be continually at work forthe Employer before he or she is eligible forcoverage under this policy.” The length of theWaiting Period is established by theEmployer and specified on the Employer’sApplication for Group Insurance.

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Individuals Eligible forCoverageEmployees are eligible for coverage under thispolicy following the fulfillment of theapplicable Waiting Period.

A former Employee deemed to be anEmployee by the Employer but on paid leaveof absence when this policy takes effect iseligible for coverage as an Employeeprovided that:

• The individual is not Disabled;

• The leave of absence is an Employer-approved paid leave;

• The leave is of a type which is generallyavailable to all Employees in the EligibleClass of Employees (e.g., paid sick leave orsabbatical leave);

• The individual has a reasonableexpectation of continued employment withthe Employer at all times during the leaveof absence; and

• The Employer pays the required premiumfor coverage commencing on the date thispolicy takes effect.

Coverage for such Employees will extend fora maximum of two (2) years from the date thepaid leave commences.

A former Employee who is on an unpaidleave of absence or who is Disabled on thedate this policy takes effect will not beeligible for coverage under this policy until heor she resumes the active, regularperformance of job duties as a member of theEligible Class of Employees.

Effective Date of Coveragefor EmployeesTo be covered, an Employee must submit anapplication for coverage to us within thirty(30) days of initial eligibility and we mustaccept that application. (Readers arereminded that a disabled person is not an“Employee” as the term is used in this policy.)

We will accept timely applications submittedby Employees who have fulfilled the requiredWaiting Period. In all other cases, we mayrequire extraordinary evidence that theperson is, in fact, an Employee within themeaning of this policy, that the person is notDisabled on the date of application and willnot be Disabled on the initial date ofcoverage, and that the person is not likely tobecome Disabled in the foreseeable future.

The Effective Date of Coverage for anEmployee means “the first day on which thatEmployee, if he or she becomes Disabled, iseligible for Benefits under the terms of thispolicy.”

Effective Date of Coveragefor Disabled PersonsAn individual who would be an Employee butfor being Disabled on the date this policytakes effect, and who submits a timelyapplication which is otherwise acceptable tous, will be accepted as a Covered Employeeon the date on which the individual is nolonger Disabled and resumes active Employeestatus, subject to any required WaitingPeriod.

There is one exception: If the policy becomeseffective for an Eligible Class of Employees

6 IC-2574-254-0797

Article IIIEligibility and Dates of Coverage

that was not previously covered by a groupLong Term Disability plan, the Effective Dateof Coverage for an individual who would bean Employee but for being Disabled on thedate this policy takes effect, with respect toany loss which is attributable to the same orrelated causes as the subject Disability or isconnected with the subject Disability in anyway, will be the date immediately followingsix (6) months of regular performance as anEmployee, subject to any required WaitingPeriod.

The application for coverage must besubmitted to us no later than thirty (30) daysafter the individual ceases to be Disabled andresumes the status of Employee.

Effective Date of Coveragefor Persons on UnpaidLeave of AbsenceA former Employee who is on an unpaid leaveof absence on the date this policy takes effect,and who submits a timely application whichis acceptable to us, will be accepted as aCovered Employee on the date on which theindividual resumes active Employee status,subject to any required Waiting Period andprovided that the individual is not Disabled.

There is one exception: If the policy becomeseffective for an Eligible Class of Employeesthat was not previously covered by a groupLong Term Disability plan, the Effective Dateof Coverage for a former Employee who is onan unpaid leave of absence on the date thispolicy takes effect and who suffered from anillness or injury during that unpaid leave ofabsence, with respect to any loss resultingfrom a Disability which is attributable to thesame or related causes as the subject illnessor injury or is connected with the subjectillness or injury in any way, will be the dateimmediately following six (6) months ofregular performance as an Employee, subjectto any required Waiting Period.

The application for coverage must besubmitted to us no later than thirty (30) daysafter the individual resumes active Employeestatus.

Coverage During UnpaidLeave of AbsenceCoverage under this policy may be continuedfor a former Employee deemed to be anEmployee by the Employer who is on anunpaid leave of absence provided that:

• We receive written notice in advance of aleave approved by the Employer whichadvises of the Employer’s intent to continuecoverage under this policy during the leaveand includes the beginning and endingdates of the leave and the amount of theCovered Employee’s Covered Salary;

• The unpaid leave is a temporary, short-term leave of one year or less and theCovered Employee is reasonably expectedto resume the active, regular performanceof job duties as a member of the EligibleClass of Employees at the end of the leave;

• Such leaves of absence and the right tocontinue coverage under this policy duringan unpaid leave of absence are available toall eligible Employees in the Eligible Classof Employees covered by this policy;

• The Covered Salary during the unpaidleave is the Covered Employee’s pre-leaveCovered Salary, and not the salary theCovered Employee will earn upon his orher return to work at the end of the leave;and

• The Employer pays the required premiumfor coverage throughout the leave ofabsence.

The policy’s requirement of a Covered Lossapplies as well to coverage during an unpaidleave of absence. Therefore, if the CoveredEmployee becomes Disabled during the leave,Benefits will not begin until after both theElimination Period and the scheduledduration of the leave have expired. TheElimination Period can be satisfied duringthe leave of absence, after the Date ofDisability.

IC-2574-254-0797 7

Late Application forCoverageAn Employee who applies for coverage underthis policy more than thirty (30) days afterhis or her date of initial eligibility will bedenied coverage unless he or she provideswritten evidence of insurability which we, inour sole discretion, deem sufficient. If weapprove the application, coverage will takeeffect on the first day of the month followingour date of approval.

Coverage Termination DatesA Covered Employee’s coverage under thispolicy will terminate on the earliest of thefollowing dates:

• The date this policy terminates for anyreason;

• The date of expiration of the period forwhich the last required premium wastimely paid;

• The date on which the Covered Employeeceases to be an Employee, ceases to be amember of the Eligible Class of Employees,or otherwise ceases to be eligible forcoverage by this policy;

• The date on which the Maximum BenefitPeriod specified on the Benefit Summary iscompleted;

• The date on which a former CoveredEmployee, who is Disabled on the date thispolicy ceases to cover the Eligible Class ofEmployees of which he or she was amember, returns to active work for theEmployer;

• The date which is one (1) year from thedate on which the Covered Employeecommenced an Employer-approved unpaidleave of absence; or

• The date which is two (2) years from thedate on which the Covered Employeecommenced an Employer-approved paidleave of absence.

Generally, the date on which a CoveredEmployee ceases to be an Employee is thelast date on which he or she actively performsjob duties for the Employer. However,coverage will continue beyond that date for aCovered Employee whose individualemployment contract is not renewed,provided that a preexisting collectivebargaining agreement or Employer policyprovides for extended coverage andprovided further that all required premiumsare paid. Coverage will continue (i) for theduration specified in the collective bargainingagreement or Employer policy, or (ii) untilAugust 31 of the year in which the individualemployment contract is not renewed, or (iii)until the date on which the former CoveredEmployee begins the active, regularperformance of job duties as an employee ofanother employer in a non-temporaryoccupation, whichever occurs first.

Suspension of CoverageCoverage of a Covered Employee will besuspended during any military leave foractive duty (including periods of annualtraining) in the National Guard or any activeor reserve component of the military forces ofany state or country including the UnitedStates. Coverage will resume upon theEmployee’s return to active, regularperformance of job duties with the Employer,except that if the military leave ends duringa period in which the Employee would notregularly be scheduled to work for theEmployer, coverage will resume on the datethe Employee could have resumed active,regular performance of job duties for theEmployer had such date been a regularlyscheduled work day.

8 IC-2574-254-0797

This policy establishes two distinct stages of asingle, continuous Period of Disability forwhich you may qualify for Benefits. The firststage is the first twenty-four (24) months ofone Period of Disability and the second stageis any remainder of that Period of Disability.To qualify for Benefits during the firsttwenty-four (24) months of one Period ofDisability, you must satisfy the requirementsin the sections below entitled “Qualificationfor Benefits During the First Twenty-four (24)Months of Disability” and “Satisfying theElimination Period.” To qualify for Benefitsafter the first twenty-four (24) months, youmust, in addition, satisfy the requirements inthe section below entitled “Qualification forBenefits After Twenty-four (24) Months ofDisability” on page 10.

Qualification for BenefitsDuring the First Twenty-four(24) Months of DisabilityDuring the first twenty-four (24) months ofone Period of Disability, you will qualify for amonthly Benefit when:

• We have received persuasive andunrebutted proof of a Covered Loss in theform required by the sections in Article Ventitled “Notice of Claim” and “Proof ofLoss” on page 12;

• You have satisfied the applicableElimination Period; and

• You have applied for all other benefits,including Social Security DisabilityInsurance benefits (hereinafter referred toas SSDI benefits) and WisconsinRetirement System disability benefits(hereinafter referred to as WRS disability

benefits), for which you may be eligible dueto Disability or Total Disability.

Satisfying the EliminationPeriodThe length of the Elimination Period isspecified on the Benefit Summary and beginson the Date of Disability. In order to receiveBenefits under this policy, you must beDisabled for the duration of the specifiedElimination Period.

Benefits will be paid only after you completethe Elimination Period and prove a CoveredLoss. During the first year of Disability noBenefits will be paid during months in whichyou would ordinarily receive no salary or wagesfrom the Employer. You may use sick leave tosatisfy the Elimination Period and may satisfythe Elimination Period during a period inwhich you would not ordinarily receive incomefrom the Employer (e.g., vacation periods,holidays, or the summer months).

If, following your Date of Disability andbefore you satisfy the Elimination Period, youendeavor to resume work for the Employerbut work only ten (10) days or less, then theElimination Period will continue but will beextended by the number of days, includingany partial days, on which you worked.

If, following your Date of Disability andbefore you satisfy the Elimination Period, youreport to work for the Employer on more thanten (10) days, the Elimination Period willstart over. In that case, a new Period ofDisability will begin on the next day you areunable to work due to the same or relatedcause(s) and we will assign a new Date of

IC-2574-254-0797 9

Article IVQualification for Benefits

Disability to coincide with the first day of thenew Period of Disability.

There is an exception to the rules described inthe preceding two paragraphs: If, followingyour Date of Disability and before you satisfythe Elimination Period, you return to workfor the Employer with our approval at a jobother than your Regular Occupation insatisfaction of your mitigation obligationsdescribed in the section of Article V entitled“‘Involuntary’ Loss of Income,” on page 13,and in the section in Article VIII entitled“Duty to Make Efforts to Recover andOtherwise Mitigate Losses,” on page 21, anydays on which you work, including anypartial days, will count toward satisfaction ofthe Elimination Period.

If, during the Elimination Period, you returnto work for the Employer, and during thatreturn become Disabled due to a causeunrelated to the previous Disability, theElimination Period for your second Disabilitywill begin on the date we determine to beyour subsequent Date of Disability.

Qualification for BenefitsAfter Twenty-four (24)Months of DisabilityAfter the first twenty-four (24) months of acontinuous Period of Disability, no Benefitsare payable under this policy unless youhave applied for both SSDI benefits andWRS disability benefits before the end of thefirst twenty-four (24) months of Disability.

However, you will be eligible to receiveBenefits after twenty-four (24) months of acontinuous Period of Disability if you did notapply for SSDI benefits because you are not aparticipant in any of the programs availablethrough the Social Security Administrationand are therefore ineligible for a SocialSecurity disability benefit. Similarly, you willbe excused from the requirement of applyingfor WRS disability benefits if you are noteligible for a disability benefit from theWisconsin Department of Employee TrustFunds.

To receive Benefits under this policy after thefirst twenty-four (24) months of a Period of

Disability, you must continue to incur aCovered Loss and must be Totally Disabled.

• If you apply for SSDI benefits before theend of twenty-four (24) months of Disabilityand SSDI benefits are awarded, we willpresume that you satisfy the policy’sdefinition of Total Disability and will payyou a monthly Benefit for as long as youcontinue to be Totally Disabled, incur aCovered Loss, and receive SSDI benefits,subject to the Maximum Benefit Periodspecified on the Benefit Summary.

• If you apply for SSDI benefits before theend of twenty-four (24) months of Disabilityand SSDI benefits are not awarded, we willpresume that you do not satisfy the policy’sdefinition of Total Disability and willterminate Benefit payments at the end oftwenty-four (24) months of Disability. Inthat event, if you believe that the weight ofthe evidence clearly contradicts the SocialSecurity Administration determination, youwill have the right, upon request, to receiveour application of the Social SecurityAdministration disability standard. If wedetermine that you meet the SocialSecurity Administration disability standard(the policy’s definition of Total Disability),we will pay you a monthly Benefit for aslong as you continue to incur a CoveredLoss and continue, in our sole discretion, tomeet the policy’s definition of TotalDisability, subject to the Maximum BenefitPeriod specified on the Benefit Summary.

• If you do not apply for SSDI benefitsbecause you are ineligible for a SocialSecurity disability determination, we willapply the Social Security Administrationdisability standard to determine whetheryou are Totally Disabled as defined in thispolicy. If we determine that you meet theSocial Security Administration disabilitystandard (the policy’s definition of TotalDisability), we will pay you a monthlyBenefit for as long as you continue to incura Covered Loss and continue, in our solediscretion, to meet the policy’s definition ofTotal Disability, subject to the MaximumBenefit Period specified on the BenefitSummary.

10 IC-2574-254-0797

Notwithstanding any other provision of thispolicy, your Benefits will terminate after thefirst twenty-four (24) months of one Period ofDisability unless you meet the applicablerequirements set forth in this section.However, if your Benefits terminate becauseyou are not receiving SSDI benefits, we willreinstate your Benefits retroactive to the dateof termination if, on the date of terminationof Benefits, you had applied for and wereawaiting an initial determination by theSocial Security Administration or a decisionon an administrative appeal of an adverseinitial determination and it is subsequentlydetermined that you were entitled to SSDIbenefits prior to the date on which Benefitsunder this policy terminated.

Change in BenefitsIf the Benefits provided by this policy arechanged while coverage is in effect, thechanges will apply to you only if your Periodof Disability begins after the effective date ofthe change. The Benefits in force on yourDate of Disability will continue to be theBenefits applicable for you during that Periodof Disability even if the Benefits provided bythis Policy are changed after that date.

IC-2574-254-0797 11

Notice of ClaimTo initiate a claim for Benefits, you mustsend us written notice of your claim withinninety (90) days of the claimed Disability.The purpose of this notice is to alert us to theexistence and nature of your possible CoveredLoss and allow us to obtain information anddocuments necessary to process your claim ina timely fashion. The Notice of Claim mustinclude the following information:

• Your Regular Occupation

• The name of your Employer

• The date you were last actively at work foryour Employer

• The date upon which you claim you firstbecame Disabled

• Your Annual Salary on that date

• The nature of the illness or injury causingyour claimed Disability

• The nature and extent of your claimeddisabling impairment(s)

• The identity of your diagnosing andtreating Physician(s)

You may submit the Notice of Claim to us byletter or by the appropriate form which youcan obtain either at the Employer’s businessoffice or by calling us. We will mail the formwithin ten (10) days of receiving your request.You can obtain information about how toinitiate and substantiate a claim for Benefitsby calling us at 1-800-279-4000.

Proof of LossTo substantiate a claim for Benefits, youmust provide proof of a Covered Loss. Thisrequires both proof of Disability and proofthat the Disability has caused an actual lossof Covered Salary. The Notice of Claim willinform us of the claimed Disability but actualProof of Loss must be filed within ninety (90)days of the first loss of Covered Salary causedby the claimed Disability.

You are responsible for providing us withproof, which we deem sufficient, that youhave suffered a Covered Loss (a loss ofCovered Salary because of Disability). If youdo not provide the required Proof of Loss, youare not entitled to Benefits.

We will not pay any cost you may incur inestablishing initial and continuous Proof ofLoss.

Section 631.81 of the Wisconsin Statutesextends the time permitted to file the Noticeof Claim or Proof of Loss for twelve (12)months beyond the ninety (90) days requiredby the policy, but only if the Company is notprejudiced by the failure to file the Notice ofClaim or Proof of Loss within ninety (90) daysand it was not reasonably possible for theCovered Employee to meet the 90-day timelimit.

We often find that our ability to accuratelyinvestigate and adjudicate claims ofDisability is significantly reduced when theclaim is filed more than three (3) monthsafter the claimed Date of Disability. Becauseour interest is prejudiced when claims arefiled more than ninety (90) days after theonset of the disability, we reserve the right todeny such claims.

12 IC-2574-254-0797

Article VClaims Procedure

The required Proof of Loss will not becomplete until appropriate and sufficientdeclarations have been submitted by you, bythe Employer, and by your treatingPhysician. You can obtain acceptable formsfor this purpose either at the Employer’sbusiness office or by calling us. We will mailthe forms within ten (10) days of receivingyour request. You may use the appropriateEmployee form as your Notice of Claim (seethe last paragraph of the section entitled“Notice of Claim” above) as well.

To substantiate the cause and extent of theCovered Loss, we will require informationfrom the Employer regarding your inability toperform the duties of your RegularOccupation and objective evidence confirmingyour Disability from a Physician licensed andqualified to diagnose the impairment(s)causing the claimed Disability, in addition tothe information you provide yourself. APhysician’s declaration that you are Disabled,without accompanying objective medicaland/or psychiatric evidence, is not sufficientto substantiate your Disability.

Continuing Proof of LossAfter you begin receiving Benefits, we willregularly require proof of continuing CoveredLosses, including reports by your treatingPhysician which provide objective medicaland/or psychiatric evidence, to confirm yourcontinued Disability. Continuing Proof of Losswill not be deemed sufficient unless you areunder the Regular Care of a Physician.

“Involuntary” Loss ofIncomeYour loss of income must be “involuntary.”The following illustrates this point: If, duringa Period of Disability, a position for whichyou are qualified and capable of performingbecomes available with your Employer andthe position is offered to you, you mustperform the work and earn the wage. If youdo not take the position, the loss of thatamount of Covered Salary which would havebeen replaced by the income from thatposition will not be due to Disability or TotalDisability and you will not be entitled toBenefits to replace that amount.

IC-2574-254-0797 13

When you have timely proven that you havebeen Disabled for the entirety of theElimination Period and have incurred aCovered Loss, we will pay you a monthlyBenefit. The monthly Benefit is the GrossBenefit reduced by the amount of certaindisability benefits available to you from othersources and by a portion of any income youearn during the Period of Disability. This NetBenefit is the amount owed to you.

You must apply for all other benefits forwhich you may be eligible due to yourDisability or Total Disability. These otherbenefits are referred to in this policy as OtherIncome Benefits and are discussed more fullyin the section below entitled “Other IncomeBenefits” on page 16. Because this policyindemnifies the loss of a fixed percentage ofCovered Salary, a Net Benefit is paid to youonly when the total of all Other IncomeBenefits and earnings fails to provide theassured portion of Covered Salary.

Gross BenefitYour Gross Benefit is the product of yourMonthly Covered Salary and the Percent ofCovered Salary Insured by this policy. ThePercent of Covered Salary Insured is specifiedon the Benefit Summary.

Covered Salary will not exceed the MaximumCovered Salary specified on the BenefitSummary or the Annual Salary on whichpremiums have been paid. The MaximumCovered Salary is subject to periodic reviewand adjustment. When the MaximumCovered Salary is adjusted, we will revise theEmployer’s Benefit Summary to reflect thatadjustment. Your Benefit Summary is notrevised, however, and therefore may show anoutdated figure for Maximum Covered Salary.

You may consult the Employer’s BenefitSummary, or call us, for the currentlyeffective Maximum Covered Salary.

Net BenefitYour Gross Benefit will be reduced by fiftypercent (50%) of any income you earn duringany month through the active performance ofany gainful activity. In addition, if the sum ofthe remaining fifty percent (50%) of suchearnings and your Gross Benefit exceeds yourMonthly Covered Salary, your Gross Benefitwill be further reduced by that excess amount.

If you were earning income (in addition toyour Covered Salary from the Employer) priorto becoming Disabled, we will not reduce yourGross Benefit by any portion of those monthlyearnings unless the level of the earningsincreases after your Disability. In that event,the Gross Benefit will be reduced by theamount of any increase in the mannerdescribed in the preceding paragraph.

After the Gross Benefit has been adjusted forearned income, it will be further reduced bythe total of all Other Income Benefits forwhich you are eligible. The Benefit resultingfrom this further reduction is the Net Benefitdue you.

In no event will we reduce your Gross Benefitby the amount of a cost of living adjustmentin your Social Security Disability Insurance(SSDI) benefit if or to the extent that such areduction will result in payment of a lowerNet Benefit than the original Net Benefit wepaid to you before the first SSDI cost of livingadjustment was applied.

The concepts described in this section areillustrated by Example 3 in the Appendix tothis policy.

14 IC-2574-254-0797

Article VIBenefits

Reduction in EarningsWe recognize that some impairments areprogressive in nature and are not immediatelydisabling. Therefore, if you suffer animpairment which precludes the performanceof some but not all of the duties of yourRegular Occupation, and if your subsequentDisability results in a claim for Benefits, wewill not consider any intermediate reduction insalary when calculating Benefits. Instead, wewill determine Covered Salary, and henceGross Benefit, by using your single highestAnnual Salary for the two (2) year periodimmediately preceding your Date of Disability,provided that you prove that the reductionfrom the higher salary was involuntary anddue to physical or mental impairment(s).Covered Salary will be determined in thismanner even though the premium has beenpaid on the basis of the reduced salary ratherthan the Covered Salary.

Benefits DuringRehabilitation andRetrainingWe also recognize that many CoveredEmployees will need to resume partial workresponsibilities in a rehabilitation orretraining program and encourage you toparticipate in such programs. When we havepreapproved the continuation of Benefits inthe context of such work activity, then Benefitswill continue, subject to the integration and allother provisions of the policy.

Integration of Other Income BenefitsThe calculation of the Net Benefit due yourequires adjusting your Gross Benefit by thetotal amount of all Other Income Benefitsreceived by or available to you. This processof adjusting your Gross Benefit by theamount of Other Income Benefits to arrive atyour Net Benefit is called integration. Theconcepts described in this section and in thesection below entitled “Other IncomeBenefits” are illustrated by Example 2 in theAppendix to this policy.

Your Gross Benefit will always be reduced byall Other Income Benefits which areavailable to you or which you are eligible toreceive as a result of your Disability,whether or not you apply for and receivesuch payments or benefits. These OtherIncome Benefits are listed in the sectionbelow entitled “Other Income Benefits.”

To receive the full measure of income assuredby this policy, you must apply for all OtherIncome Benefits for which you may be eligibleas soon as you are entitled to Benefits underthis policy. If you do not apply for and activelypursue in good faith all Other Income Benefitsfor which you may be eligible, we may makeour own conclusion as to whether you areentitled to those benefits. If we reasonablyand in good faith determine that you areprobably entitled to Other Income Benefits,we will estimate the amount of those benefitsand reduce the Gross Benefit by thatestimated amount as of the date on which wedeem you were eligible to receive those OtherIncome Benefits. Integration of the estimatedamount of those Other Income Benefits thatwe have determined are available to you willcontinue until you provide us with proof thatyou have filed the appropriate application(s)for those Other Income Benefits.

We will not estimate the amount of OtherIncome Benefits nor reduce your GrossBenefit while applications or administrativeappeals for Other Income Benefits arepending, provided:

• You apply for in good faith and pursue toour satisfaction all Other Income Benefitsfor which we determine you might beeligible;

• You designate, at our request, an agentendorsed by us as your representative inthe application process and cooperate withthat representative at all stages of theapplication process;

• You keep us timely informed of the status ofall applications for Other Income Benefits;

• You sign a Reimbursement Agreement; and

• You pursue, when approved by us,administrative appeals of Other IncomeBenefit denials.

IC-2574-254-0797 15

Other Income Benefits

Types of BenefitsThe other benefits available to or received byyou because of Disability or Total Disabilityare referred to as Other Income Benefits.Your Gross Benefit will be reduced by theamount of all Other Income Benefits whichyou are eligible to receive as a result ofDisability or Total Disability including, butnot limited to, the following:

1. Any payment from a governmental (federal,state, or political subdivision of a state)benefit plan, under any name, title, ordescription and whether insured or fundedby the governmental unit, for whicheligibility and level of benefit is based inwhole or in part on your Disability or TotalDisability, including, but not limited to, thefollowing:

• Social Security Disability Insurance(SSDI) benefits, including Auxiliaryand/or Dependents’ benefits based onyour Social Security earnings record.Integration of Auxiliary and Dependents’Social Security benefits will occur ifindicated on the Benefit Summary.

If you are eligible for SSDI benefits butchoose instead to receive a SocialSecurity Retirement Insurance benefit,we will estimate the amount of the SSDIbenefit which you were eligible to receiveand will integrate Benefits under thispolicy with the estimated amount. Insuch event, your Benefits under thispolicy will cease two (2) years from theDate of Disability.

• Wisconsin Retirement System (WRS)disability benefits. If you are eligiblefor WRS disability benefits but chooseinstead to receive a WRS retirementannuity or a WRS separation benefit, wewill estimate the amount of the WRSdisability benefit which you were eligibleto receive and will integrate the Benefitsunder this Policy and the estimatedamount.

• Worker’s Compensation benefits, orbenefits from any other paymentprogram established under similar law,including amounts payable due tosettlement of a disputed claim bystipulation or compromise.

2. Unemployment Compensation benefitsyou receive for or during any period inwhich we pay you a Benefit.

3. Any payment from an Employer-sponsored (group or individual) LongTerm or Short Term Disability plan, ifany portion of the premium is paid by theEmployer.*

4. Any payment pursuant to the “work loss”coverage available through individual no-fault automobile insurance policies.*

5. Sick leave pay you receive from yourEmployer. In determining whether you areentitled to sick leave pay and whether thatsick leave pay is subject to integration, wewill apply the rule(s) established by yourEmployer which are uniformly applicable toEmployees’ entitlement to receive sickleave pay.

In the absence of an established Employerrule regarding sick leave pay, we willintegrate the cash value of all disability-related, cash or non-cash, benefits whichare based on your accrued sick leave andprovided to you by your Employer.

* When integrating these benefit payments,your Gross Benefit will be reduced by onlythat portion of the benefit which exceedsthe percentage of your Covered Salary thatthis policy does not insure.

Lump Sum Award of BenefitsIf you receive Other Income Benefits in alump sum payment, we will integrate thosebenefits and the Benefits under this policy inone of the following ways:

1. If you receive a retroactive lump sumpayment of Other Income Benefits for aperiod of time during which you receivedBenefits under this policy, we may reduceone or more subsequent Benefit payments

16 IC-2574-254-0797

under this policy to fully recoup theamount of the overpayment resulting fromthe retroactive Other Income Benefitaward, or we may require that youimmediately repay in full the overpaymentresulting from the retroactive OtherIncome Benefit award.

2. If you receive a prospective lump sumpayment of Other Income Benefits whichcovers a period of time during which youwill receive Benefits under this policy, wewill allocate that lump sum payment over areasonable number of months in the futureand will reduce your Gross Benefit by themonthly pro rata share.

Income Not Subject to IntegrationWe will not reduce your Gross Benefit by theamount of other income or benefits youreceive which you could have received even ifyou were not Disabled or Totally Disabled.For example, we will not reduce your GrossBenefit by the amount you receive for accruedvacation pay, severance pay, deferredcompensation, or retirement income benefits.

Appeal of a Denial of Other IncomeBenefitsWhen we determine that reasonable groundsexist to appeal a denial of Other IncomeBenefits, you must actively pursue in goodfaith the administrative appeal(s) of suchdenial. We will pay the reasonable andnecessary costs of administrative appeals thatwe approve regardless of the outcome of theappeal and will pay the reasonable andnecessary costs of a non-approvedadministrative appeal if the appeal issuccessful.

Benefit CalculationThe Benefit calculation methods described inthis section are illustrated by Example 1 inthe Appendix to this policy.

Contract Day MethodDuring the twenty-four (24) month periodfollowing your Date of Disability, yourBenefits will be calculated on a contract daybasis. Under this method, your Covered

Salary is divided by the number of scheduledwork days in your contracted work year toyield a daily rate of pay. Each month, thisdaily rate of pay is multiplied by the numberof scheduled work days you are unable towork due to Disability and then by thePercent of Covered Salary Insured indicatedon the Benefit Summary to yield a GrossBenefit for that month.

The contract day method of Benefitcalculation is intended to calculate, eachmonth, the amount of salary you would haveearned except for your Disability. Forexample, if your Covered Salary is $38,000and your work year has 190 scheduled work days, your daily rate of pay is $200.If you satisfy your Elimination Period onNovember 12 and have 11 remainingscheduled work days in November, yourGross Benefit for November would becalculated using a salary value of $2,200($200/day times 11 days) multiplied by thePercent of Covered Salary Insured stated onyour Benefit Summary. If you were Disabledall of December and had 18 scheduled workdays in December, your Gross Benefit forDecember would be calculated using a salaryvalue of $3,600 ($200/day times 18 days).Under this payment method, it should benoted that, during the first twenty-four (24)months of a Period of Disability, we will notpay a Benefit to you in months duringwhich you are not ordinarily scheduledto work. Thus, if you are Disabled in Julyand had no scheduled work days in July, yourGross Benefit for July would be zero.

Monthly Method – Annualization ofSalaryTo facilitate the administration of the policyand to establish consistent monthly Benefitpayments for each Covered Employee, we will“annualize” Covered Salary after twenty-four(24) months of a Period of Disability. To“annualize” your Covered Salary, we willdivide your Covered Salary by twelve (12) toyield a Monthly Covered Salary. The MonthlyCovered Salary will then be multiplied by thePercent of Covered Salary Insured indicatedon the Benefit Summary to yield your GrossBenefit.

IC-2574-254-0797 17

When Covered Salary is “annualized,” themethod of Benefit calculation changes fromthe contract day method outlined above to themonthly method. We will always “annualize”your Covered Salary twenty-four (24) monthsafter your Date of Disability. Monthly Benefitpayments based on the “annualized” CoveredSalary begin in the twenty-fifth (25th) monthof a Period of Disability.

We may “annualize” your Covered Salarysooner if we deem the monthly method to be amore reasonable and equitable method ofcalculating Benefit payments. We may also“annualize” Covered Salary, and calculateand pay Benefits accordingly, when youbecome eligible for Other Income Benefitswhich are paid on a monthly basis (e.g., SSDIbenefits or WRS disability benefits).

We have the right, at our sole discretion,to pay the Net Benefit due you for any twelve (12)-month period in a lump sum atthe beginning of that period.

Cost of Living AdjustmentsThis policy may include an amendment whichspecifies a Cost of Living Adjustment (COLA)Benefit. The amendment, if in force, providesfor an annual adjustment to your CoveredSalary. The adjusted Covered Salary is thenused to calculate a new monthly Benefit. Weoffer two types of COLAs:

• The WEA Cost of Living AdjustmentBenefit; and

• The CPI-U Cost of Living AdjustmentBenefit.

The Benefit Summary indicates which, ifeither, of the COLA amendments applies tothis policy. If a COLA applies, the GrossBenefit will be recalculated annually usingthe recalculation procedure set forth in theapplicable Cost of Living AdjustmentAmendment.

Benefit Termination DatesBenefit payments pursuant to this policyterminate on the earliest of the followingdates:

1. The date on which the Maximum BenefitPeriod specified on the Benefit Summaryhas been reached;

2. The date of your death;

3. The date on which you fail to furnish proof satisfactory to us that you remainDisabled or Totally Disabled as describedin Article IV; or

4. The date which is twenty-four (24) monthsafter your Date of Disability unless:

• You have applied for WRS disabilitybenefits (unless you are not eligible for adisability determination from theWisconsin Department of EmployeeTrust Funds);

• You are receiving Social SecurityDisability Insurance benefits (unlessyou are ineligible for a Social Securitydisability determination because you arenot a participant in any benefit programsoffered through the Social SecurityAdministration); and

• We have found you to be TotallyDisabled.

If Benefits under this policy are suspendedfor six (6) consecutive months due to yourfailure to comply with all of the requirementsof this policy, we can irrevocably terminateall further Benefits under this policy.

If you cease to be Disabled or TotallyDisabled on a date which is more than twelve(12) months after you satisfied theElimination Period and on which you wouldnot regularly be scheduled to work (e.g., thesummer months or periods between academicterms), Benefits under this policy willterminate on the day before the date that youwould regularly be scheduled to resumeactive employment.

18 IC-2574-254-0797

Company’s Right ofRecoupmentWe will not pay Benefits to you before yousign a Reimbursement Agreement and thatAgreement is on file with us.

Whenever we have made payments to you inexcess of the amount required by theprovisions of this policy, or during periods oftime for which you subsequently receive aretroactive benefit from any Other IncomeBenefit source, you will reimburse us for anysuch excess, duplicate, or erroneouspayments.

Upon request, you must execute and deliverto us such documents as may be required anddo whatever else is necessary to secure ourrights to recover any excess, duplicate, orerroneous payments.

You must reimburse us in a satisfactory andtimely manner for any payments made towhich you were not entitled under the termsof this policy. Such reimbursement will bedue and payable immediately upon ournotification to and demand of you. Or, at ouroption, the subsequent payment of Benefits orthe refund of any premium owed you by usmay be reduced or refused as a setoff andapplied toward such reimbursement. If youdelay in notifying us of your receipt of anOther Income Benefit or in makingreimbursement to us, we will have the rightto charge interest at a reasonable rate on thedelinquent amount owed us.

Our acceptance of premium or other fees, orour providing or paying of Benefits, does notconstitute a waiver of our rights to enforcethe provisions of this section in the future.The provisions of this section are in additionto, and not in lieu of, any other rights orremedies available to us at law or in equity.

IC-2574-254-0797 19

1. Benefits are not payable with respect toany Disability or Total Disability:

• Which results from service in the armedforces of any country or results from anact of war, whether declared orundeclared.

• Which occurs during any military leavefor active duty (including training duty)in the National Guard or any active orreserve component of the military forcesof any state or country including theUnited States.

• Which is caused or contributed to byintentionally self-inflicted injuries orattempted suicide.

• Arising from your participation incommitting a felony.

2. Benefits are not payable with respect toany Period of Disability, or portion thereof,during which:

• You are not under the Regular Care of aPhysician.

• You fail to satisfy your obligations as setforth in this policy.

• You are incarcerated for any reason.

We have the right to suspend Benefitpayments during any period in which alimitation of the policy applies.

20 IC-2574-254-0797

Article VIIExclusions and Limitations

Duty to Make Efforts toRecover and OtherwiseMitigate LossesYou must make a good faith effort to recoverfrom, or reduce the severity of, your disabilityand the resulting loss of income, or you willforfeit Benefits. The policy requires you totake a variety of actions in this regard,including, but not limited to, the following:

1. You must accept any position within abroad definition of Regular Occupation thatyou can perform and the Employer makesavailable during the first twenty-four (24)months of Disability regardless of whetherthe compensation for such work is less thanyour Covered Salary. The income earnedwill be treated as described in Article VI in the section entitled “Net Benefit” onpage 14.

2. You must arrange for and utilize theRegular Care of a Physician. In addition,you must pursue any reasonable medicalprocedure or treatment which would likelyameliorate or end your Disability andwhich does not pose unreasonable risks.

3. You must submit periodic, objectivemedical and/or psychiatric evidence from aPhysician to substantiate that the CoveredLoss is due to and continues to result fromDisability.

4. You must engage in appropriate medicaland/or occupational rehabilitationprograms where these exist and canreasonably be expected to enable you toreturn to work, and notify us of suchparticipation.

5. You must appeal denials of Other IncomeBenefits, and actively pursue that appealin good faith, when we determine thatreasonable grounds exist for an appeal andrequest you to do so.

6. You must promptly provide us with allinformation which we reasonablydetermine is necessary to validate,calculate, document, or administer yourclaim for Benefits, including immediatenotice and periodic verification of thereceipt of earnings and Other IncomeBenefits.

Duty to Furnish InformationTo receive Benefits under this policy, youmust authorize and direct medical careproviders and sources of earnings or OtherIncome Benefits to provide us with any andall information and records that wereasonably determine to be relevant to thedetermination of Benefits or eligibility forBenefits. We do not pay any fees charged forsubmitting this information to us and anysuch costs will be your responsibility.

IC-2574-254-0797 21

Article VIIIResponsibilities of a Disabled Covered Employee

Company’s Right to ExamineWe have the right to require that you beexamined by a health care professional of ourchoice and at our expense, when and as oftenas it is reasonable with respect to any claimfor Benefits.

We also have the right to require yourcooperation in a vocational assessment by avocational expert of our choice and at ourexpense, when and as often as it is reasonablewith respect to any claim for Benefits.

Covered Employee’s Failureto ComplyWe have the right to suspend Benefitsduring any portion of a Period of Disability inwhich you fail to comply with all of therequirements set forth in the policy.

We have the further right to terminateirrevocably all further Benefits under thispolicy when Benefits have been suspended fora period of six (6) consecutive months due toyour failure to comply with all of therequirements of this policy.

22 IC-2574-254-0797

In some circumstances, we may pay Benefitsto you even though another party orinsurance company is liable for your loss ofincome. The following provisions establish ourright, in such circumstances, to seekrepayment from the liable party or parties ofthe Benefits we pay you. This right is knownas the right of subrogation. You mustcooperate with us in our attempts to recoverpayments from the liable party or parties.

We retain all rights of subrogation withrespect to Benefits provided to you pursuantto this policy. In accepting the Benefits paidby us, you also accept the obligations below:

• To subrogate us to the rights, claims,interests, and causes of action which youmay have against any party who may beliable for your injury, illness, or other loss,including any payments to which you areentitled under the uninsured orunderinsured motorist provisions of anautomobile insurance policy or a no-faultinsurance policy, to the extent that we haveprovided Benefits for lost income under thispolicy;

• To transfer and assign such rights, claims,interests, and causes of action to uscontemporaneous with, and to the extentof, any Benefits paid by us;

• To cooperate with us in any effort torecover Benefits paid by us from otherswho are liable for your injury, illness, orother loss. Such cooperation will include,but not be limited to, providing us withreasonable prior notice of and opportunityto participate in any claim by you againstany such liable party or any settlement ofsuch claim; and

• To make no settlement or compromise withany party or take any action to prejudiceour subrogation rights.

Your right to be made whole for your losstakes priority over our right to recover theBenefits paid to you from the party who isliable for the loss. However, this provisiondoes not obligate us to waive legal rights thatwe may have.

We are entitled to recover from you anyreasonable costs and attorney’s fees which weincur in enforcing our rights under thisArticle against you.

IC-2574-254-0797 23

Article IXSubrogation

Rights of the CoveredEmployeeIf we deny your claim for Benefits, you havethe following rights under this policy:

1. The right to submit, within the timerequired by this policy, all relevantevidence of entitlement to Benefits.

2. The right to a full and fair review of allclaims submitted pursuant to this policy.

3. The right to a written explanation of thereason(s) for any denial of a claim forBenefits, including reference to the policyprovisions on which the denial was based.

4. The right to examine any document in ourpossession relevant to your claim.

5. The right to appeal the denial of a claim forBenefits to our Board of Directors pursuantto our Appeal Procedure, provided thatthe appeal is properly submitted withinsixty (60) days of the date on our finalnotice of denial of the claim. The AppealsCommittee of the Board of Directors willissue a written decision on the appeal.

6. The right to obtain a written explanation ofthe procedures and requirements of ourAppeal Procedure, including any necessaryforms, by writing to our President orGeneral Counsel at WEA InsuranceCorporation, P.O. Box 7338, Madison,Wisconsin 53707-7338.

Legal Actions by theCovered EmployeeNo action at law or in equity may bebrought to recover on this policy unlessyou have exhausted the AppealProcedure referred to above. No suchaction may be brought after the expiration ofthree (3) years after the time written Proof ofLoss is required to be furnished. However,this three-year period within which you mayfile a legal action will not include the periodof time starting from the date we receive yourappeal and ending on the date the AppealsCommittee issues its written decision on theappeal.

24 IC-2574-254-0797

Article XAppeal Procedure

IC-2574-254-0797 25

Appendix

EXAMPLE 1: BENEFIT CALCULATION METHODS

The Benefit calculation methods described in Article VI in the section entitled “Benefit Calculation”are illustrated below.

A. BENEFIT CALCULATION METHOD: CONTRACT DAY

Date of Disability: February 24, 1996Elimination Period: 60 daysDate eligible for Benefits: April 24, 1996Disability ends: April 23, 1997Covered Salary: $38,000.00Percent of Covered Salary Insured: 90%Days in contracted work year: 190 daysDaily Gross Benefit: $180.00 ($38,000.00 ÷ 190 x 90%)

April 1996 5 $ 180.00 $ 900.00

May 1996 22 $ 180.00 $ 3,960.00

June 1996 4 $ 180.00 $ 720.00

July 1996 0 $ 180.00 $ -0-

August 1996 9 $ 180.00 $ 1,620.00

September 1996 21 $ 180.00 $ 3,780.00

October 1996 22 $ 180.00 $ 3,960.00

November 1996 20 $ 180.00 $ 3,600.00

December 1996 15 $ 180.00 $ 2,700.00

January 1997 20 $ 180.00 $ 3,600.00

February 1997 20 $ 180.00 $ 3,600.00

March 1997 15 $ 180.00 $ 2,700.00

April 1997 17 $ 180.00 $ 3,060.00

Total 190 $ 180.00 $ 34,200.00

Month/YearNumber of Days

PayableDaily Gross

Benefit Net Benefit Paid

26 IC-2574-254-0797

B. BENEFIT CALCULATION METHOD: ANNUALIZED SALARY

Date of Disability: February 24, 1996Elimination Period: 60 daysDate eligible for Benefits: April 24, 1996Disability ends: April 23, 1997Covered Salary: $36,000.00Percent of Covered Salary Insured: 90%Monthly Gross Benefit: $2,700.00 ($36,000.00 ÷ 12 x 90%)Daily Gross Benefit for partial month: $90.00 ($2,700.00 ÷ 30)

April 1996 7 $ 90.00 $ 630.00

May 1996 30 $ 90.00 $ 2,700.00

June 1996 30 $ 90.00 $ 2,700.00

July 1996 30 $ 90.00 $ 2,700.00

August 1996 30 $ 90.00 $ 2,700.00

September 1996 30 $ 90.00 $ 2,700.00

October 1996 30 $ 90.00 $ 2,700.00

November 1996 30 $ 90.00 $ 2,700.00

December 1996 30 $ 90.00 $ 2,700.00

January 1997 30 $ 90.00 $ 2,700.00

February 1997 30 $ 90.00 $ 2,700.00

March 1997 30 $ 90.00 $ 2,700.00

April 1997 23 $ 90.00 $ 2,070.00

Total 360 $ 90.00 $ 32,400.00

Month/YearNumber of Days

PayableDaily Gross Benefitfor Partial Month Net Benefit Paid

IC-2574-254-0797 27

EXAMPLE 2: INTEGRATION OF OTHER INCOME BENEFITS

The concepts described in Article VI in the sections entitled “Integration of Other Income Benefits”and “Other Income Benefits” are illustrated by the examples below.

EXAMPLE 2A: INTEGRATION OF WORKER’S COMPENSATION BENEFITS

Date of Disability: February 24, 1996Elimination Period: 60 daysDate eligible for Benefits: April 24, 1996Covered Salary: $38,000.00Percent of Covered Salary Insured: 90%Days in contracted work year: 190 daysDaily Gross Benefit: $180.00 ($38,000.00 ÷ 190 days x 90%)Monthly Gross Benefit: $2,850.00 ($38,000.00 ÷ 12 months x 90%)Worker’s Compensation effective: February 27, 1996Weekly benefit: $120.00Worker’s Compensation ceases: September 15, 1996

To allow proper integration, the Worker’s Compensation weekly benefit must be converted to adaily benefit:

Worker’s Compensation weekly benefit: $120.00Divide by 6 ÷ 6(Worker’s Compensation pays 6 days/week) $ 20.00 (Worker’s Compensation daily benefit)

1. If Benefits are paid on a contract day basis, the daily Gross Benefit payable will be reduced bythe Worker’s Compensation daily benefit for each day such benefit is received.

2. BENEFIT CALCULATION METHOD: ANNUALIZED SALARY

If Benefits are paid on a monthly basis because the Covered Salary has been annualized, the fullmonthly Worker’s Compensation benefit will be used for integration purposes.

To determine the monthly Worker’s Compensation benefit, multiply the daily Worker’sCompensation benefit by the number of days Worker’s Compensation benefits are paid in a givenmonth. (This number will vary and can be obtained by simply subtracting the number ofSundays in the month.)

Example: Worker’s Compensation benefits payable for May 1996

$20.00 x 27 days = $540.00

Monthly Gross Benefit: $ 2,850.00Monthly Worker’s Compensation benefit: $ 540.00Monthly Net Benefit: $ 2,310.00

28 IC-2574-254-0797

3. BENEFIT CALCULATION METHOD: CONTRACT DAY/PARTIAL MONTH

If Benefits are paid on a contract day basis for a partial month, the monthly Worker’sCompensation benefit must be divided by the total number of days Benefits could have beenpayable in that month to arrive at the daily Worker’s Compensation integration amount.

Example: May 1996

$540.00 ÷ 22 days payable = $24.54 (Daily Worker’s Compensation amount to be integrated.)

Worker’s Compensation weekly benefit: $120.00*Worker’s Compensation daily benefit: $20.00 ($120.00 ÷ 6)Worker’s Compensation monthly benefit: $540.00 ($20.00 x 27 days)

Daily Gross Benefit: $180.00Number of days Benefits payable 22 days

Gross Benefit: $ 3,960.00 ($180.00 x 22 days)Worker’s Compensation integration amount: $ 539.88 ($24.54 x 22 days)Net Benefit: $ 3,420.12

* This amount is based on a set weekly Worker’s Compensation benefit such as Temporary TotalDisability (TTD) benefits. Temporary Partial Disability (TPD) benefits will fluctuate. You mustsubmit actual Worker’s Compensation benefits paid and earnings received during any period youreceive TPD benefits.

Worker’s Compensation benefits paid to you during the summer months will be included in ourintegration calculations.

Minor variances in calculations are due to rounding.

IC-2574-254-0797 29

EXAMPLE 2B: INTEGRATION OF SSDI BENEFITS IN FIRST YEAR OF DISABILITY(Method is the same for integration with WRS disability benefits in first year.)

BENEFIT CALCULATION METHOD: CONTRACT DAY

Date of Disability: February 24, 1996Elimination Period: 60 daysDate eligible for Benefits: April 24, 1996Annualization Date: May 1, 1997Covered Salary: $38,000.00Percent of Covered Salary Insured: 90%Days in contracted work year: 190 daysDaily Gross Benefit: $180.00 ($38,000.00 ÷ 190 days x 90%)SSDI effective date: September 1, 1996Monthly SSDI benefit: $1,085.00Daily SSDI benefit: $56.00**

**Daily SSDI calculation for integration purposes:

1) Multiply the monthly benefit by the number of months benefits will be received prior to annualization of salary ($1,085.00 x 8 months = $8,680.00); and

2) Divide the product by the number of days WEA Insurance will pay Benefits during that same time period ($8,680.00 ÷ 155 = $56.00/day).

April 1996 (5 days) $ 900.00 $ -0- $ 900.00

May 1996 (22 days) $ 3,960.00 $ -0- $ 3,960.00

June 1996 (4 days) $ 720.00 $ -0- $ 720.00

July 1996 (0 days) $ -0- $ -0- $ -0-

August 1996 (9 days) $ 1,620.00 $ -0- $ 1,620.00

September 1996 (21 days*) $ 3,780.00 $ 1,176.00 $ 2,604.00

October 1996 (22 days*) $ 3,960.00 $ 1,232.00 $ 2,728.00

November 1996 (20 days*) $ 3,600.00 $ 1,120.00 $ 2,480.00

December 1996 (15 days*) $ 2,700.00 $ 840.00 $ 1,860.00

January 1997 (20 days*) $ 3,600.00 $ 1,120.00 $ 2,480.00

February 1997 (20 days*) $ 3,600.00 $ 1,120.00 $ 2,480.00

March 1997 (15 days*) $ 2,700.00 $ 840.00 $ 1,860.00

April 1997 (22 days*) $ 3,960.00 $ 1,232.00 $ 2,728.00

Total 195 days $ 35,100.00 $ 8,680.00 $26,420.00

Month and Number ofDays Benefits Payable

Gross BenefitPayable (90% ofCovered Salary)

SSDI(effective 9/1/96)

Net BenefitPaid

* Integration days = 155

30 IC-2574-254-0797

In this 12-month period (April 24, 1996, through May 1, 1997):

WEA Insurance pays: $26,420.00SSDI pays: $ 8,680.00 (8 months x $1,085.00)

WEA Insurance integrates: $ 8,680.00 ($56.00 x 155 days)

Total Benefit entitlement = $34,200.00 (90% of Annual Salary = .90 x $38,000.00)Total benefits received = $35,100.00 ($26,420.00 + $8,680.00)***

***Total benefits received exceed one year’s total Benefit entitlement by $900.00 because the firstmonth of disability was a partial month and contract day Benefits are paid until the “annualizationdate” which in this case is May 1, 1997. Thus, five contract days are paid from April 24, 1997, toMay 1, 1997. (5 days x $180.00/day = $900.00)

Minor variances in calculations are due to rounding.

IC-2574-254-0797 31

EXAMPLE 2C: INTEGRATION OF COMBINED SSDI & WRS DISABILITY BENEFITS

BENEFIT CALCULATION METHOD: CONTRACT DAY

Date of Disability: February 24, 1996Elimination Period: 60 daysDate eligible for Benefits: April 24, 1996Annualization date: May 1, 1997Covered Salary: $38,000.00Percent of Covered Salary Insured: 90%Days in contracted work year: 190 daysDaily Gross Benefit: $180.00 ($38,000.00 ÷ 190 days x 90%)SSDI effective date: September 1, 1996Monthly SSDI benefit: $1,085.00Daily SSDI benefit: $56.00 ($1,085.00 x 8 months ÷ 155 days)**WRS effective date: August 1, 1996Monthly WRS benefit: $1,476.00Daily WRS benefit: $81.00 ($1,476.00 x 9 months ÷ 164 days)**

**Daily SSDI/WRS calculation for integration purposes.

1) Multiply the monthly SSDI/WRS benefit by the number of months SSDI/WRS benefits will bereceived prior to annualization of salary; and

2) Divide the product by the number of days WEA Insurance will pay Benefits during that sametime period.

April 1996 (5 days) $ 900.00 $ -0- $ -0- $ 900.00

May 1996 (22 days) $ 3,960.00 $ -0- $ -0- $ 3,960.00

June 1996 (4 days) $ 720.00 $ -0- $ -0- $ 720.00

July 1996 (0 days) $ -0- $ -0- $ -0- $ -0-

August 1996 (9 days*) $ 1,620.00 $ -0- $ 729.00 $ 891.00

September 1996 (21 days*) $ 3,780.00 $ 1,176.00 $ 1,701.00 $ 903.00

October 1996 (22 days*) $ 3,960.00 $ 1,232.00 $ 1,782.00 $ 946.00

November 1996 (20 days*) $ 3,600.00 $ 1,120.00 $ 1,620.00 $ 860.00

December 1996 (15 days*) $ 2,700.00 $ 840.00 $ 1,215.00 $ 645.00

January 1997 (20 days*) $ 3,600.00 $ 1,120.00 $ 1,620.00 $ 860.00

February 1997 (20 days*) $ 3,600.00 $ 1,120.00 $ 1,620.00 $ 860.00

March 1997 (15 days*) $ 2,700.00 $ 840.00 $ 1,215.00 $ 645.00

April 1997 (22 days*) $ 3,960.00 $ 1,232.00 $ 1,782.00 $ 946.00

Total 195 days $ 35,100.00 $ 8,680.00 $ 13,284.00 $13,136.00

Month and Number ofDays Benefits Payable

Gross BenefitPayable (90% ofCovered Salary)

SSDI(Effective

9/1/96)

Net BenefitPaid

WRS(Effective

9/1/96)

* Integration days = 155 days for SSDI benefits; 164 days for WRS benefits

32 IC-2574-254-0797

In this 12-month period (April 24, 1996, through May 1, 1997):

WEA Insurance pays: $13,136.00SSDI pays: $ 8,680.00 (8 months x $1,085.00)WRS pays: $13,284.00 (9 months x $1,476.00)

WEA Insurance integrates: $21,964.00 ($8,680.00 + $13,284.00)

Total Benefit entitlement = $34,200.00 (90% of Annual Salary = .90 x $38,000.00)Total benefits received = $35,100.00 ($13,136.00 + $8,680.00 + $13,284.00)***

***Total benefits received exceed one year’s total Benefit entitlement by $900.00 because the firstmonth of disability was a partial month and contract day Benefits are paid until the “annualizationdate” which in this case is May 1, 1997. Thus, five contract days are paid from April 24, 1997, toMay 1, 1997 (5 days x $180.00/day = $900.00).

Minor variances in calculations are due to rounding.

IC-2574-254-0797 33

EXAMPLE 2D: INTEGRATION OF SSDI BENEFITS AFTER “ANNUALIZATION” OF SALARY (Showing COLA implementation and “Social Security Freeze.”)

BENEFIT CALCULATION METHOD: ANNUALIZED SALARY

Date of Disability: February 24, 1996Initial Covered Salary: $36,000.00Percent of Covered Salary Insured: 90%Initial Monthly Gross Benefit: $2,700.00 ($36,000.00 ÷ 12 months x 90%)Initial SSDI benefit: $1,060.00

Initial “Social Security Freeze” calculation:Initial Gross Benefit: $2,700.00Initial SSDI Benefit: - 1,060.00Original Net Benefit and “Freeze” figure: $1,640.00

(The “Freeze” figure refers only to the initial reduction for SSDI benefits.)

If, at any time, the monthly Net Benefit is the same as or higher than the freeze figure, we will usethat Net Benefit and reduce it by all other benefits and earnings. If the monthly Net Benefit islower than the freeze figure, we will use the freeze figure and reduce it by all other benefits andearnings.

SSDI Cost of Living Adjustment:

Increase of 2.9% effective December 1, 1996: $1,060.00 x 1.029 = $1,090.00Note: The Social Security Administration rounds SSDI benefits to next lower dollar.

First LTD COLA: March 1, 1997 ($36,000.00 x 2.0% = $720.00)*New Covered Salary: $36,720.00New Monthly Gross Benefit: $2,754.00 ($36,720.00 ÷ 12 x 90%)

*Note: Please see the WEA Cost of Living Adjustment Benefit on page 41 or the CPI-U Cost ofLiving Adjustment Benefit on page 44 for details of COLA calculation.

In no event will we reduce your Gross Benefit by the amount of a cost of living adjustment in yourSocial Security Disability Insurance (SSDI) benefit if or to the extent that such a reduction willresult in a lower Net Benefit than the original Net Benefit we paid to you before the first SSDI costof living adjustment was applied. In effect, this means that, while you are receiving Benefits, yourtotal income from all sources (policy Benefits, Other Income Benefits, and earnings) will increaseeach year by at least the amount of your SSDI cost of living adjustment.

Monthly Benefit after March 1, 1997:

Monthly Gross Benefit: $2,754.00Monthly SSDI benefit: - 1,090.00Monthly Net Benefit: $1,664.00

Minor variances in calculations are due to rounding.

34 IC-2574-254-0797

EXAMPLE 3: INTEGRATION OF EARNINGS

The concepts described in Article VI in the section entitled “Net Benefit” are illustrated below:

BENEFIT CALCULATION METHOD: CONTRACT DAY

Date of Disability: February 24, 1996Elimination Period: 60 daysDate eligible for Benefits: April 24, 1996Covered Salary: $38,000.00Percent of Covered Salary Insured: 90%Days in contracted work year: 190 daysDaily Covered Salary: $200.00 ($38,000.00 ÷ 190)Daily Benefit: $180.00 ($200.00 x 90%)Return to work half-time (50%): September 1, 1996Daily earnings: $105.00 (current salary $39,900.00* ÷ 190 days x 50%)Return to work full-time: February 3, 1997

*Note: Salary increased with new contract year.

WEA Insurance reduces your Gross Benefit by 50% of any income you earned during any monththrough the active performance of any gainful activity. In addition, if the sum of the remaining 50%of such earnings and your Gross Benefit exceeds your Covered Salary, your Gross Benefit will befurther reduced by that excess amount. Your earnings and Benefits in combination may equal butnot exceed 100% of your pre-disability Covered Salary.

Daily calculations:

$180.00 Daily Gross Benefit- 52.50 Daily earnings ($105.00 x 50%)$127.50 Daily Benefit before checking for excess earnings

Check for excess earnings:

$ 180.00 Gross Benefit+ 52.50 Remaining 50% of earnings$ 232.50 Total Benefits and earnings exceed Daily Covered Salary- 200.00 Daily Covered Salary$ 32.50 Benefit must be reduced by this excess

Final calculation:

$ 180.00 Gross Benefit- 52.50 50% of daily earnings- 32.50 Amount by which remaining 50% of earnings exceeds Daily Covered Salary

$ 95.00 Net Benefit

IC-2574-254-0797 35

Monthly Calculations:

April 1996 (5 days) $ 900.00 $ -0- $ 900.00

May 1996 (22 days) $ 3,960.00 $ -0- $ 3,960.00

June 1996 (4 days) $ 720.00 $ -0- $ 720.00

July 1996 (0 days) $ -0- $ -0- $ -0-

August 1996 (9 days) $ 1,620.00 $ -0- $ 1,620.00

September 1996 (21 days*) $ 3,780.00 $ 2,205.00 $ 1,995.00

October 1996 (22 days*) $ 3,960.00 $ 2,310.00 $ 2,090.00

November 1996 (20 days*) $ 3,600.00 $ 2,100.00 $ 1,900.00

December 1996 (15 days*) $ 2,700.00 $ 1,575.00 $ 1,425.00

January 1997 (20 days*) $ 3,600.00 $ 2,100.00 $ 1,900.00

February 1997 (0 days) $ -0- $ -0- $ -0-

Total 140 days $ 24,840.00 $ 10,290.00 $16,510.00

Month and Number ofDays Benefits Payable

Gross BenefitPayable (90% ofCovered Salary)

Earnings(effective 9/1/96)

Net BenefitsPaid

* Integration days = 98

During your half-time return to work, your earnings and Benefits in combination can equal but notexceed 100% of your pre-disability Covered Salary.

100% of pre-disability income for return to work periodSeptember 1, 1996, through January 31, 1997: $19,600.00 (98 days x $200.00)

Earnings - September 1, 1996, through January 31, 1997: $10,290.00 (98 days x $105.00)Benefits - September 1, 1996, through January 31, 1997: $ 9,310.00 (98 days x $95.00)

Total Benefits and earnings for return to work periodSeptember 1, 1996, through January 31, 1997: $19,600.00

Total Benefits and earnings for entire period of disabilityApril 24, 1996, through January 31, 1997: $26,800.00 ($16,510.00 + $10,290.00)

If you are working at another position and earning income before you become Disabled, and if youare able to continue working in that position after you become Disabled, we will not reduce yourGross Benefit by any portion of the income you earn at that other position. If, after Disability, youare able to increase your earnings from this other position, we will reduce your Gross Benefit bysuch increase in earnings in the manner noted above.

Minor variances in calculations are due to rounding.

36 IC-2574-254-0797

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IC-2574-254-0797 37

Amendments

These amendments are not part of thispolicy unless they are listed on your

Benefit Summary.

38 IC-2574-254-0797

This amendment is only applicable if your Benefit Summaryindicates “Minimum Benefit: 25% of Gross Benefit”

WEA Insurance CorporationGroup Long Term Disability

Policy and Certificate Amendment

In consideration of the mutual agreement between the WEA Insurance Corporation and theEmployer, the Group Long Term Disability Policy and Certificate, to which this amendment isattached and made a part, is hereby amended as follows:

Minimum Benefit

The following paragraph is hereby added to the section entitled “Net Benefit” in Article VI:

Any reduction of your Gross Benefit by the amount of Other Income Benefits received by oravailable to you will not reduce your Net Benefit for any month to less than twenty-fivepercent (25%) of your Gross Benefit. In applying this Minimum Benefit for any period of lessthan one (1) month, a daily pro rata percentage will be used.

Except as expressly stated above, this amendment does not waive, alter, or extend any of theprovisions or exclusions and limitations of the policy.

Amendment Effective Date – The effective date of this amendment is coincident with theEffective Date stated on the Benefit Summary.

IC-2574-254-0797 39

This amendment is only applicable if your Benefit Summaryindicates “Minimum Benefit: $50.00”

WEA Insurance CorporationGroup Long Term Disability

Policy and Certificate Amendment

In consideration of the mutual agreement between the WEA Insurance Corporation and theEmployer, the Group Long Term Disability Policy and Certificate, to which this amendment isattached and made a part, is hereby amended as follows:

Minimum Benefit

The following paragraph is hereby added to the section entitled “Net Benefit” in Article VI:

Any reduction of your Gross Benefit by the amount of Other Income Benefits received by oravailable to you will not reduce your Net Benefit for any month to less than Fifty Dollars($50.00). In applying this Minimum Benefit for any period of less than one (1) month, a dailypro rata percentage will be used.

Except as expressly stated above, this amendment does not waive, alter, or extend any of theprovisions or exclusions and limitations of the policy.

Amendment Effective Date – The effective date of this amendment is coincident with theEffective Date stated on the Benefit Summary.

40 IC-2574-254-0797

This amendment is only applicable if your Benefit Summaryindicates “Minimum Benefit: $100.00”

WEA Insurance CorporationGroup Long Term Disability

Policy and Certificate Amendment

In consideration of the mutual agreement between the WEA Insurance Corporation and theEmployer, the Group Long Term Disability Policy and Certificate, to which this amendment isattached and made a part, is hereby amended as follows:

Minimum BenefitThe following paragraph is hereby added to the section entitled “Net Benefit” in Article VI:

Any reduction of your Gross Benefit by the amount of Other Income Benefits received by oravailable to you will not reduce your Net Benefit for any month to less than One HundredDollars ($100.00). In applying this Minimum Benefit for any period of less than one (1) month,a daily pro rata percentage will be used.

Except as expressly stated above, this amendment does not waive, alter, or extend any of theprovisions or exclusions and limitations of the policy.

Amendment Effective Date – The effective date of this amendment is coincident with theEffective Date stated on the Benefit Summary.

IC-2574-254-0797 41

This amendment is only applicable if your Benefit Summaryindicates “WEA COLA”

WEA Insurance CorporationGroup Long Term Disability

Policy and Certificate Amendment

In consideration of the mutual agreement between the WEA Insurance Corporation and theEmployer, the Group Long Term Disability Policy and Certificate, to which this amendment isattached and made a part, is hereby amended as follows:

WEA Cost of Living Adjustment Benefit

The following provision is hereby added to Article VI:

If Disabled, you will be entitled to an annual cost of living adjustment to your monthly Benefitsunder this policy commencing on the later of the following dates:

• The first day of the first month which is twelve (12) months from the date you satisfy the Elimination Period, or

• The first day of the first month following the date on which changes in annual salaries for the teacher group are made effective for purposes of coverage and premium amounts under the policy.

The Monthly Covered Salary for purposes of this Amendment is the Monthly Covered Salary asdefined in Article II of the policy.

Adjusted Monthly Covered Salary is defined as your Monthly Covered Salary plus the accumulatedannual cost of living adjustments resulting from application of this Amendment.

Benefit Recalculation ProceduresIf you are paid on the basis of the teachers’ salary schedule, your Gross Benefit will berecalculated pursuant to the following procedure:

1. We determine your Monthly Covered Salary on your Date of Disability. Your step and laneplacement on the salary schedule are fixed as of your Date of Disability and will remain fixed forthe entire Period of Disability.

2. In the first year of entitlement to the cost of living adjustment, your Monthly Covered Salary ismultiplied by one hundred percent (100%) plus the annual percent increase (or minus theannual percent decrease) in salary for your step and lane, as determined from the teacher salaryschedule in effect on the date the cost of living adjustment is to be applied, to arrive at yourAdjusted Monthly Covered Salary.

42 IC-2574-254-0797

3. The cost of living adjustment will be applied annually, except if no relevant salary increase is implemented for the teacher group for a given year, no cost of living adjustment will be appliedin that year. In that case, the cost of living adjustment(s) will be retroactively applied to the firstday of the month following the effective date of the new teacher salary schedule when that newsalary schedule becomes effective and retroactive premium is paid.

4. In subsequent years, your Adjusted Monthly Covered Salary is multiplied by one hundredpercent (100%) plus the annual percent increase (or minus the annual percent decrease) insalary for your step and lane, as determined from the teacher salary schedule in effect on eachdate the cost of living adjustment is to be applied, to arrive at your new Adjusted MonthlyCovered Salary each year.

5. Your Gross Benefit is recalculated by multiplying the Adjusted Monthly Covered Salary by thePercent of Covered Salary Insured in effect under this policy on your Date of Disability.

In no event will your Gross Benefit exceed the Maximum Gross Benefit in effect under this policyon the date the cost of living adjustment is to be applied.

If you are not paid on the basis of the teachers’ salary schedule, your Gross Benefit will berecalculated pursuant to the procedure set forth below. For the purposes of applying this cost ofliving adjustment, we determine annual salary increases and decreases relative to a comparisonteacher salary. This comparison salary is calculated by averaging the following three salariesfrom the teachers’ salary schedule: (1) BA Step O, (2) MA Step O, and (3) MA Step 10. We willdetermine the percent increase in this comparison salary using the teacher salary schedule in effecton your Date of Disability and the teacher salary schedule in effect on the date the cost of livingadjustment is to be applied.

1. In the first year of entitlement to the cost of living adjustment, your Monthly Covered Salary onyour Date of Disability is multiplied by one hundred percent (100%) plus the annual percentincrease (or minus the annual percent decrease) in the comparison teacher salary, as determinedfrom the teacher salary schedule in effect on the date the cost of living adjustment is to beapplied, to arrive at your Adjusted Monthly Covered Salary.

2. The cost of living adjustment will be applied annually, except if no relevant salary increase is implemented for the teacher group for a given year, no cost of living adjustment will be appliedin that year. In that case, the cost of living adjustment(s) will be retroactively applied to the firstday of the month following the effective date of the new teacher salary schedule when that newsalary schedule becomes effective and retroactive premium is paid.

3. In subsequent years your Adjusted Monthly Covered Salary is multiplied by one hundred percent(100%) plus the annual percent increase (or minus the annual percent decrease) in thecomparison teacher salary, as determined from the teacher salary schedule in effect on each datethe cost of living adjustment is to be applied, to arrive at your new Adjusted Covered Salary eachyear.

4. Your Gross Benefit is recalculated by multiplying your Adjusted Monthly Covered Salary by thePercent of Covered Salary Insured in effect under this policy on your Date of Disability.

In no event will your Gross Benefit exceed the Maximum Gross Benefit in effect under this policyon the date the cost of living adjustment is to be applied.

IC-2574-254-0797 43

Integration of Other Income BenefitsYour recalculated Gross Benefit will be subject to the reductions required by the provisions ofArticle VI, in the sections entitled “Net Benefit,” on page 14, and “Benefits During Rehabilitationand Retraining,” on page 15, in effect under this policy on the date on which the cost of livingadjustment is to be applied.

Whenever the amount of the Social Security Disability Insurance (SSDI) benefit or the WisconsinRetirement System (WRS) disability benefit received by or available to you is increased, your GrossBenefit will be reduced by the amount of any such increase. However, in no event will we reduceyour Gross Benefit by the amount of a cost of living adjustment in your SSDI benefit if or to theextent that such reduction will result in payment of a lower Net Benefit than the original NetBenefit we paid to you before the first SSDI cost of living adjustment was applied. In effect, thismeans that, while you are receiving Benefits, your total income from all sources (policy Benefits,Other Income Benefits, and earnings) will increase each year by at least the amount of your SSDIcost of living adjustment. This concept is illustrated by Example 2D in the Appendix to the policy.

Except as expressly stated above, this amendment does not waive, alter, or extend any of theprovisions or exclusions and limitations of the policy.

Amendment Effective Date – The effective date of this amendment is coincident with theEffective Date stated on the Benefit Summary.

44 IC-2574-254-0797

This amendment is only applicable if your Benefit Summaryindicates “CPI-U COLA”

WEA Insurance CorporationGroup Long Term Disability

Policy and Certificate Amendment

In consideration of the mutual agreement between the WEA Insurance Corporation and theEmployer, the Group Long Term Disability Policy and Certificate, to which this amendment isattached and made a part, is hereby amended as follows:

CPI-U Cost of Living Adjustment BenefitThe following provision is hereby added to Article VI:

If Disabled, you will be entitled to an annual cost of living adjustment to your monthly Benefitsunder this policy beginning on the first September 1 which is at least twelve (12) months from yourDate of Disability. Your Gross Benefit will be recalculated annually using a cost of livingadjustment to your Monthly Covered Salary, as described below:

The Monthly Covered Salary for purposes of this Amendment is the Monthly Covered Salary asdefined in Article II of the policy.

Adjusted Monthly Covered Salary is defined as your Monthly Covered Salary plus the accumulatedannual cost of living adjustments resulting from application of this Amendment.

The cost of living adjustment will be based on the U.S. City Average, All Items, Consumer PriceIndex for All Urban Consumers with an Index Base of 1982-84 as published by the U.S.Department of Labor, Bureau of Labor Statistics (hereinafter referred to as the CPI-U).

The cost of living adjustment will be determined by using the annual percent change in the CPI-Umeasured from June 1 of the preceding year through May 31 of the year in which the cost of livingadjustment is to be applied. The annual percent change in the CPI-U may be positive, negative, orzero.

We will annually calculate your Adjusted Monthly Covered Salary as described below eachSeptember 1 after you become entitled to the cost of living adjustment.

Your Gross Benefit will be recalculated as follows:

1. In the first year of entitlement to the cost of living adjustment, your Monthly Covered Salary ismultiplied by one hundred percent (100%) plus the percent increase (or minus the percentdecrease) in the CPI-U for the annual period listed above, to arrive at your Adjusted MonthlyCovered Salary.

2. In subsequent years, your Adjusted Monthly Covered Salary is multiplied by one hundredpercent (100%) plus the annual percent increase (or minus the annual percent decrease) in theCPI-U to arrive at your new Adjusted Monthly Covered Salary each year.

IC-2574-254-0797 45

3. Your Gross Benefit is recalculated by multiplying your Adjusted Monthly Covered Salary by thePercent of Covered Salary Insured in effect under this policy on your Date of Disability.

In no event will your Gross Benefit exceed the Maximum Gross Benefit in effect under this policyon September 1 of the year in which the cost of living adjustment is to be applied.

Integration of Other Income BenefitsYour recalculated Gross Benefit will be subject to the reductions required by the provisions ofArticle VI, in the sections entitled “Net Benefit,” on page 14, and “Benefits During Rehabilitationand Retraining,” on page 15, in effect under this policy on September 1 of the year in which the costof living adjustment is to be applied.

On September 1 of each year, your Gross Benefit will be reduced by the amount of any SocialSecurity Disability Insurance (SSDI) benefit increases and Wisconsin Retirement System (WRS)disability benefit increases received by or available to you during the previous twelve (12) monthperiod. However, in no event will we reduce your Gross Benefit by the amount of a cost of livingadjustment in your SSDI benefit if or to the extent that such reduction will result in payment of alower Net Benefit than the original Net Benefit we paid to you before the first SSDI cost of livingadjustment was applied. In effect, this means that, while you are receiving Benefits, your totalincome from all sources (policy Benefits, Other Income Benefits, and earnings) will increase eachyear by at least the amount of your SSDI cost of living adjustment. This concept is illustrated byExample 2D in the Appendix to the policy.

Except as expressly stated above, this amendment does not waive, alter, or extend any of theprovisions or exclusions and limitations of the policy.

Amendment Effective Date – The effective date of this amendment is coincident with theEffective Date stated on the Benefit Summary.