SCHEDULE <continued) POLICY --------------------Maximum Benefit for Total Periods To Age 65: Before Age 61 To Age 65 At Age 61 but before Age 62 48 Months At Age 62 but before Age 63 42 Months At Age 63 but before Age 64 36 Months At Age 64 but before 30 Age 65 Months At or after Age 65 but before Age 75 24 Months At or after Age 75 12 Months ----------------------------Residual Disability Maximum Benefit Period For Residual Work Incentive Period Disability 24 3 Months Months ---------------------------L-ifet im e Continuation Elimination Period Benefit Amount Lifetime for Benefit Maximum Long Term Care Amount for Policy Long Term Care Policy $108,000 Days $3,000 per month 90 ----------------------------Table of Additional Annual Premium to Prior Age 65 Fixed Cost of Living Adjustment Option Rider Effective Date: October 25, 2007 $167.30
POLICY SCHEDULE <continued) --------------------Maximum Benefit Periods for Total To Age 65: Before Age 61 To Age 65 At Age 61 but before Age 62 48 Months At Age 62 but before Age 63 42 Months At Age 63 but before Age 64 36 Months At Age 64 but before Age 65 30 Months At or after Age 65 but before Age 75 24 Months At or after Age 75 12 Months ----------------------------Residual Disability Maximum Benefit Period For Work Incentive Period 3 Months Residual Disability 24 Months ---------------------------L-ifet im e Continuation Elimination Period Benefit Amount for Long Term Care Policy Lifetime Maximum Benefit Amount for Long Term Care Policy 90 Days $3,000 per month $108,000 ----------------------------Table of Additional Annual Premium Prior to Age 65 Fixed Cost of Living Adjustment Option Rider Effective Date: October 25, 2007 $167.30
FIN428r4_income_disability_policy_sample.docx