VoluntaryLife InsuranceThrough the Independent School Group Life and Disability Insurance Trust

?* To be considered full-time, you must

work the minimum number of hours per week, as specified by your school.

What about coverage for my family?If you buy coverage for yourself, you may buy units of $5,000 up to $150,000 for your lawful spouse. You may also purchase coverage for your children in units of $1,000, up to a maximum of $10,000. The amount ofcoverage for any dependent may not exceed 50% of your own amount.

Eligible children include your unmarried children,from live birth until age 19, or until age 25 if a full-time student.

If you and your spouse both work for the sameemployer, and are both eligible for this insurance asemployees, you may not cover each other as dependentsand only one of you may insure any dependent children.

How much can I buy?Your Voluntary Life comes in $10,000 units. You may buy as many as you need, from a minimum of $10,000 (one unit), up to a maximum of $300,000 (30 units), not to exceed five times your basic annual earnings.

IS/IT® Voluntary Life Insurance

Am I eligible for this coverage?You are eligible to participate in this plan if you are a permanent, full-time* employee of a participating school of the Independent School Group Life andDisability Insurance Trust (IS/IT), and working in the United States.

What about medical inquiries?If you become initially eligible on or after the effectivedate and are under age 70, you may purchase up to$100,000 without proof of good health. If you are 70 orolder, you may purchase up to $30,000. These amountsare known as the amount of “Guarantee Issue.” Theamount of Guarantee Issue available for your spouse is $50,000 if he/she is under age 70, and $15,000 if yourspouse is 70 or older. The amount of Guarantee Issueavailable for your child is $10,000.

Guarantee Issue is available only if you apply within 31 days of initial eligibility. Insurance coverage in excess of these amounts is subject to proof of good health and approval of your application by Union Security Insurance Company. Until you are approved for the excess amount, only the guarantee issue amounts shown above will become effective – or the amount for which you enrolled, if less.

Coverage for your dependent children is also available without proof of good health, provided theyare enrolled within 31 days of their initial eligibility.

Proof of good health will be required for any amountof coverage if the application is made after 31 days of initial eligibility.

What happens if I get sick?The Disability Benefit provision of the policy addresses this situation. If you become disabled prior to age 60 while insured for Voluntary Life, and remaincontinuously disabled as defined in the policy for the qualifying period, your coverage (including anyDependent Life coverage) will continue without further premium payment until the earliest of: the date you recover; reach age 65; or retire. The qualifyingperiod will match the qualifying period for your group IS/IT Long Term Disability, or six months if you do not have group Long Term Disability coverage through IS/IT.

For disabilities beginning between ages 60 and 65,the insurance may be continued for up to one year, butnot past the earliest of: age 65; the date you recover; or the date you retire.

IS/IT® Voluntary Life Insurance

$IS/IT® Voluntary Life Insurance

Is there an accelerated benefit?Yes. If you or your insured spouse have at least $10,000 in coverage, have been insured for at least sixmonths, and have a medical condition which has beendiagnosed by a doctor as life-threatening and results in an expected life span of 12 months or less, you mayrequest up to 80% of your Voluntary Life coverage to be paid immediately, to a maximum of $240,000, or$120,000 for your spouse.

The written consent of the beneficiary must beobtained for any request of more than 50% of the death benefit. The remainder of your or your spouse’sbenefit (minus an interest charge) is still payable to the beneficiary after the insured person’s death.

What if I leave a participating school?If you terminate your employment and you are not disabled, you may continue Life coverage up to$300,000 for yourself, and up to $150,000 for your dependent spouse, until your 65th birthday, by paying premiums to Union Security Insurance Company via direct billing to your home.

Proof of good health isn’t required, but you mustapply within 31 days of the date your group coverageends. This portable coverage is for Life and DependentLife only, and has no cash value or disability benefit.The portable certificate may be converted to an individual policy, which will accumulate cash value.

Your Voluntary Life coverage may also be converted to an individual policy without proof of good health, if you apply and pay the premium within 31 days of the date coverage terminates. If benefits are terminatedbecause of non-payment of premium, conversion is not available.

Are there any limitations or exclusions?There is a suicide limitation for both employees anddependents, which disallows payment of benefits fordeath from suicide during the first year of new or additional coverage; only a return of premium paymentwould be paid to the beneficiary. The Disability Benefit,the Accelerated Benefit and Portability provisions alsohave some limitations or exclusions, and there are also age-related reductions for employees and theirdependent spouses.

How much does Voluntary Life cost?Monthly premium rates for you and your spouse are based on your respective,attained ages and tobacco usage status (for employee only), and will changeannually on any January 1 when you have moved to a higher age band. Please refer to your enrollment materials for cost information.

How much life insurance do I need?Do you have enough life insurance coverage to meet

your financial obligations or to help your family remain

financially secure if something happens to you? Fill in

the blanks to determine your needs.

My family would need this much to pay for monthly housing (mortgage, rent) $ ___________________

My family would need this this much to pay for other monthly debts (credit cards, car payment, etc.) $ ___________________

My family would need this much to meet other monthly expenses (day care, utilities, clothing, etc.) $ ___________________

Total monthly expenses (1 + 2 + 3) $ ___________________

I want my family to have financial support for this amount of time (12, 24, 36, 72 months, etc.) ___________________

Number of months of financial support times total monthly expenses. (5 x 4) $ ___________________

My children would need this much to pay for their education (example: $25,000 per child) $ ___________________

Total financial support desired (6 + 7) $ ___________________

I already have this amount of coverage. $ ___________________

I should consider choosing this much Voluntary Life Insurance (8 - 9 = total) $ ___________________

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How do I sign up?Complete the Voluntary Life Insurance EmployeeApplication. Make sure you answer all questions that apply to your benefit elections.

Your coverage will become effective on the entrydate specified in the group policy, provided you are actively at work on that date. Otherwise, your coverage will become effective on the day you return to your full-time duties.

Dependent coverage will become effective according to the policy entry date, unless yourdependent is in a hospital or similar facility on that day, or if your spouse is disabled as defined by the master policy on the effective date.

IS/IT® Voluntary Life Insurance

For this group insurance plan to become effective, the greater of five (5) lives or 25% of eligible employees must enroll. Coverage will not go into effect unless the minimum requirement is met. Union Security Insurance Company reserves the right to cancel the policy with written notice to the policyholder in the event the minimum participation falls below the required amount, or premiums are not paid.

This summary is not a certificate of insurance nor a summary plan description required by ERISA, but rather an overview of available coverage.The Policyholder holds the master policy containing all the provisions of the group plan. PLEASE NOTE: Because of individual state laws, someplan provisions are not available in all states, or may require modification.

This insurance plan is underwritten by Union Security Insurance Company2323 Grand BoulevardKansas City, MO 64108

The Independent School Group Life and Disability Insurance Trust

1316 North Union StreetWilmington, DE 19806302-656-4944

www.isminc.com

Underwritten by: Union Security Insurance Company 2323 Grand Boulevard Kansas City, MO 64108

AMOUNT OF INSURANCE AVAILABLE TO YOU

You may apply for term life insurance for yourself in $10,000 increments, up to the lesser of five times annual salary or $300,000. Up to $100,000 of coverage is available to you on a "guaranteed issue" basis; that is, without medical underwriting. Insurance above $100,000 needs medical underwriting approval from Union Security Insurance Company. Complete details are in this brochure.

If you apply for coverage for yourself, you may also apply for coverage for your spouse/domestic partner (in $5,000 increments) and your dependent children (in $1,000 increments). Up to $50,000 of guaranteed issue insurance is available for your spouse/domestic partner, and up to $10,000 for your dependent children. Higher coverage amounts for your spouse/domestic partner are available with medical underwriting approval. However, in no case can the amount of insurance for a spouse/domestic partner or a child be greater than 50% of the employee’s insurance amount. The maximum amount of coverage for dependent children is $10,000. Complete details are in this brochure.

IMPORTANT: If you do not apply when you are initially eligible, you may not apply again until a subsequent anniversary date, and you must submit proof of good health and be approved by Union Security Insurance Company before you can be covered.

VOLUNTARY TERM LIFE RATES

Age: Employee: Non-Tobacco User

price per $10,000 unit

Employee: Tobacco User

price per $10,000 unit

Spouse/ Domestic Partner: price per

$5,000 unit

Child(ren): price per

$1,000 unit

0.21 0-29 0.59 1.01 0.49

30-34 0.68 1.21 0.5935-39 1.02 1.82 0.9140-44 1.40 3.02 1.5545-49 2.30 5.05 2.5750-54 3.90 8.57 4.1255-59 6.51 13.38 5.7260-64 9.53 17.68 8.1465-69 16.52 27.54 12.1570-74 26.44 39.34 20.2475+ 70.10 85.95 49.43

Premium is paid for the first child only. All other children are included at no charge.

Employee Unit = $10,000; Spouse/Domestic Partner Unit = $5,000; Dependent Child(ren) Unit = $1,000.

The cost of coverage for children is the same regardless of the number of children in family (premium is paid for the first child only; additional children are covered at no cost).

EXAMPLE: An employee, non-tobacco user, age 38, with annual earnings of $31,000 elects $50,000 of coverage; $25,000 for spouse/domestic partner, also age 38; and $10,000 for each of three dependent children:

Employee = $ 50,000 = 5 ($10,000 units) x $1.02 = $ 5.10

Spouse/Domestic Partner = $ 25,000 = 5 ($ 5,000 units) x $ 0.91 = $ 4.55

Children = $ 10,000 = 10 ($ 1,000 units) x $ 0.21 = $ 2.10

Total Monthly Premium: $11.75

Voluntary Life Insurance Employee Application

Please return this form to: ISM Insurance Inc. 1316 North Union Street Wilmington, DE 19806-2594 302-656-4944

EMPLOYEE INFORMATION—Failure to accurately complete the questions on this application may affect the existence or amount of coverage.

Check all that apply: New Coverage Increase Coverage Add Spouse/Dependent

Proposed Effective Date Group Policy

Participation # School

Employee Name (last, first, initial)

School Address

Gender M F

Employee Date of Birth

Employee State of Residence

Employee Social Security # First Day Actively at Work (full-time, benefit-eligible employee)

# Hours Worked / Week (on a regular basis)

Employee Home or Cell Phone #

Employee Annual Contractual Salary or Annualized Earnings: (does not include overtime or bonuses)

$

Spouse/Domestic Partner Name (only if applying for coverage)

Spouse/D. Partner Date of Birth

Spouse/D. Partner Social Security #

Note – You will pay 100% of the premium for the following benefits if you choose to enroll. If applying for more than the Guaranteed Issue amount, you must complete a Proof of Good Health form and submit it with this application.

ELECTIONS ARE NOT VALID WITHOUT A SIGNATURE AT THE END OF THIS APPLICATION

VOLUNTARY LIFE INSURANCE—Employee Coverage Accept Refuse Your Employer is offering a Voluntary Life Insurance Plan which you may purchase through convenient payroll deductions. In no event can the amount of your elected Voluntary Life Insurance exceed $300,000. For timely entrants under the age of 70, the Guaranteed Issue amount available without proof of good health is $100,000. For timely entrants age 70 or over, the Guaranteed Issue amount available without proof of good health is $30,000. Please indicate your total requested benefit amount in increments of $10,000 This includes both in-force Voluntary Life coverage plus any additional amount being requested, not to exceed 5 times your annual pay. $ Have you used tobacco products (including e-cigarettes) in the last 12 months? Yes No VOLUNTARY LIFE INSURANCE – Spouse/Domestic Partner Coverage Accept Refuse You may also purchase Voluntary Life Insurance coverage for your spouse/domestic partner, in units of $5,000—not to exceed $150,000. In no event can the amount of spouse/domestic partner coverage exceed 50% of your elected amount. For timely entrants under the age of 70, the Guaranteed Issue amount available without proof of good health is $50,000. For timely entrants age 70 or over, the Guaranteed Issue amount available without proof of good health is $15,000. Please indicate your total requested benefit amount in increments of $5,000 This includes both in-force Voluntary Life coverage plus any additional amount being requested. $ If applying for coverage for a domestic partner check here . You must attach an executed Declaration of Domestic Partnership agreement to this application.

VOLUNTARY LIFE INSURANCE – Child(ren) Coverage Accept Refuse You may also purchase Voluntary Life Insurance coverage for your child(ren) or the children of your spouse/domestic partner, in units of $1,000—not to exceed $10,000. In no event can the amount of child coverage exceed 50% of your elected amount. For timely entrants, proof of good health is not required. The cost covers all eligible dependent children. (Available for unmarried children, from live birth until age 19, or until age 25 if a full-time student.) Please indicate your total requested benefit amount in increments of $1,000 This includes both in-force Voluntary Life coverage plus any additional amount being requested. $

Employee name Group Policy / Participation #

2323 Grand Boulevard Kansas City, MO 64108 Underwritten by: Union Security Insurance Company

BENEFICIARIES (1) Give FULL names and relationships of each beneficiary. (2) If primary/contingent election is not noted, the beneficiary will be considered primary. (3) Proceeds will be paid in equal shares to those primary beneficiaries who survive you unless otherwise noted. If no primary beneficiaries survive you, the proceeds will be paid in equal shares to the surviving contingent beneficiaries. (4) The Employee is automatically the beneficiary for all spouse/domestic partner and/or child coverage.

Last name First MI Relationship Primary Contingent

% Benefit

Address Date of Birth Social Security Number

Last name First MI Relationship Primary Contingent

% Benefit

Address Date of Birth Social Security Number

Last name First MI Relationship Primary Contingent

% Benefit

Address Date of Birth Social Security Number

Last name First MI Relationship Primary Contingent

% Benefit

Address Date of Birth Social Security Number

Additional beneficiary designation information provided on attached page(s). (Each additional page must be signed and dated by the employee.)

Please contact ISM if you wish to designate a Trust as beneficiary or if you wish your designation to be per stirpes. Other beneficiary forms will be required for those types of designations.

NOTE: Your employer cannot be named as the beneficiary.

MY SIGNATURE ON THIS APPLICATION INDICATES THAT I: (1) Apply for the coverages designated for which I am eligible under my employer’s plan with Union Security Insurance Company. (2) Understand if coverages have been refused, I am not entitled to benefits under those coverages and that if I want to apply later, I must furnish, at my own expense, proof of good health satisfactory to Union Security Insurance Company. (3) Authorize any required deductions from my earnings. (4) Designate the beneficiary named on this application to receive any benefits payable in the event of my death. (5) Represent that all of the information on this application is complete, correct and true to the best of my knowledge and belief. (6) Understand that I must be actively at work the minimum number of hours specified in the policy/participation agreement to remain insured.

Any person who knowingly and with intent to defraud any insurance company or other person files an application or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects person to criminal and civil penalties.

Employee’s signature: Date:

School name