Pinetop Custom Homes Summary of Benefits Group Accident Plan - if elected by employee You must be working 30 hours per week to qualify. A United Heritage Group Accident Plan provides benefits for more than 80 covered accidental injuries, related services and treatments. The cash benefit can be used however the insured chooses, from paying for unexpected and/or uncertain medical expenses (including health insurance deductibles, copay or travel to facilities) to helping with general living and everyday expenses. Employee Plan Features Closed reduction amount for dislocations and fractures Coverage Type Termination Age Dependent Plan Features Spouse Accidental Death Amount Child(ren) Accident Death Amount All other benefits

Description 50% of open reduction amount Off the Job Coverage Age 80 Description 50% of employee amount 10% of employee amount 100% of employee amount

Accidental Death $30,000 Employee $15,000 Spouse $3,000 Child Accidental Death - Common Carrier $90,000 Employee $45,000 Spouse $9,000 Child Dismemberments $30,000 Both hands or both feet or sight of both eyes $30,000 One hand and one foot $30,000 Speech and hearing in both ears $30,000 Either hand or foot and sight of one eye $15,000 Either hand or foot $15,000 Sight of one eye $15,000 Speech or hearing in both ears $5,000 Thumb and index finger of either hand Burns $1,000 Second Degree Burns $10,000 Third Degree Burns $2,500 Skin Graft This Benefit Summary is not part of your group’s Policy or the Certificate of Coverage. The policy and certificate may contain certain Limitations and Exclusions not stated in this Benefit Summary. Please see the issued Policy and Certificate of Coverage for specific plan information.

United Heritage Life Insurance Company (208) 493-6100 or Toll-Free (800) 657-6351 707 E. United Heritage Ct. Meridian, Idaho 83642-3527 P.O. Box 7777 Meridian, Idaho 83680-7777 www.unitedheritage.com

Pinetop Custom Homes Summary of Benefits Dislocations - Open Hip Knee (except patella) Ankle - bone/bones of the foot (other than toes) Collarbone Lower jaw Shoulder Elbow Wrist Bones of the hand (other than fingers) Collarbone (acromioclavicular and separation) One toe or finger Dislocations - Closed without Incomplete Dislocation Hip Knee (except patella) Ankle - bone/bones of the foot (other than toes) Collarbone Lower jaw Shoulder Elbow Wrist Bones of the hand (other than fingers) Collarbone (acromioclavicular and separation) One toe or finger Dislocations - Closed with Incomplete Dislocation Hip Knee (except patella) Ankle - bone/bones of the foot (other than toes) Collarbone Lower jaw Shoulder Elbow Wrist Bones of the hand (other than fingers) Collarbone (acromioclavicular and separation) One toe or finger

$4,000 $1,800 $1,000 $1,000 $1,000 $1,000 $1,000 $1,000 $1,000 $500 $200 $2,000 $900 $500 $500 $500 $500 $500 $500 $500 $250 $100 $500 $225 $125 $125 $125 $125 $125 $125 $125 $63 $25

This Benefit Summary is not part of your group’s Policy or the Certificate of Coverage. The policy and certificate may contain certain Limitations and Exclusions not stated in this Benefit Summary. Please see the issued Policy and Certificate of Coverage for specific plan information.

United Heritage Life Insurance Company (208) 493-6100 or Toll-Free (800) 657-6351 707 E. United Heritage Ct. Meridian, Idaho 83642-3527 P.O. Box 7777 Meridian, Idaho 83680-7777 www.unitedheritage.com

Pinetop Custom Homes Summary of Benefits Fractures - Open Reduction Depressed skull fracture Simple non-depressed skull fracture Hip, thigh (femur) Vertebrae, body of (excluding vertebral processes) Pelvis Leg (tibia and/or fibula) Bones of face or nose except mandible or maxilla Upper jaw, maxilla (except alveolar process) Upper arm between elbow and shoulder Lower jaw, mandible (except alveolar process) Shoulder blade and/or collarbone Vertebral process Forearm (radius and/or ulna), hand, and/or wrist (except fingers) Kneecap (patella) Foot (except toes) Ankle Rib Coccyx Finger, toe Fractures - Closed Reduction Depressed skull fracture Simple non-depressed skull fracture Hip, thigh (femur) Vertebrae, body of (excluding vertebral processes) Pelvis Leg (tibia and/or fibula) Bones of face or nose except mandible or maxilla Upper jaw, maxilla (except alveolar process) Upper arm between elbow and shoulder Lower jaw, mandible (except alveolar process) Shoulder blade and/or collarbone Vertebral process Forearm (radius and/or ulna), hand, and/or wrist (except fingers) Kneecap (patella) Foot (except toes) Ankle Rib Coccyx Finger, toe Chip Fracture

$6,000 $1,500 $4,000 $1,200 $1,500 $1,200 $600 $1,000 $1,000 $1,000 $1,000 $400 $1,000 $1,000 $1,000 $1,000 $400 $400 $200 $3,000 $750 $2,000 $600 $750 $600 $300 $500 $500 $500 $500 $200 $500 $500 $500 $500 $200 $200 $100

25% of Closed Fracture Benefit

Lacerations 2” to 6” with sutures Greater than 6” with sutures

$300 $600

United Heritage Life Insurance Company (208) 493-6100 or Toll-Free (800) 657-6351 707 E. United Heritage Ct. Meridian, Idaho 83642-3527 P.O. Box 7777 Meridian, Idaho 83680-7777 www.unitedheritage.com

Pinetop Custom Homes Summary of Benefits Additional Benefits Abdominal/Thoracic Surgery Benefit Accident Follow-up Benefit Acupuncture Benefit Ambulance (Air) Benefit Ambulance (Ground) Benefit Arthroscopic Surgery Benefit Blood/Plasma/Platelet Benefit Child Care Benefit Chiropractic Care Benefit Coma Benefit Concussions Benefit Daily Hospital Confinement Benefit Daily ICU Confinement Benefit Diagnostic Exam Benefit Emergency Dental Benefit (Extraction) Emergency Dental Benefit (Crown) Emergency Room Benefit Eye Injury Surgical Repair Benefit Eye Injury Removal of Foreign Object Benefit Hernia Benefit Home Health Care Benefit Hospital Admission Benefit ICU Admission Benefit Initial Physician’s Visit Benefit Joint Replacement Benefit Knee Cartilage Benefit (with repair) Knee Cartilage Benefit (without repair) Lodging Benefit Medical Appliance Benefit Paralysis Benefit (Paraplegia) Paralysis Benefit (Quadriplegia) Physical Therapy Benefit Prosthesis Benefit - Single Prosthesis Benefit - Two or more Rehabilitation Facility Benefit Ruptured Disc Benefit Tendon/Ligament/Rotator Cuff - Single Tendon/Ligament/Rotator Cuff - Two or more Tendon/Ligament/Rotator Cuff - Exploratory Transportation Benefit Urgent Care Benefit X-ray Benefit

$1,500 $75 $25 $900 $300 $300 $200 $25 $25 $10,000 $150 $200 $400 $200 $100 $300 $150 $400 $200 $150 $50 $1,000 $1,000 $75 $2,000 $750 $150 $125 $100 $5,000 $10,000 $25 $750 $1,500 $100 $750 $800 $1,000 $200 $300 $75 $50

This Benefit Summary is not part of your group’s Policy or the Certificate of Coverage. The policy and certificate may contain certain Limitations and Exclusions not stated in this Benefit Summary. Please see the issued Policy and Certificate of Coverage for specific plan information.

United Heritage Life Insurance Company (208) 493-6100 or Toll-Free (800) 657-6351 707 E. United Heritage Ct. Meridian, Idaho 83642-3527 P.O. Box 7777 Meridian, Idaho 83680-7777 www.unitedheritage.com