BECAUSE ACCIDENTS HAPPEN

An accident can happen to anyone, at any time. When employees are able to protect their finances — even when unexpected accidents happen — they can worry less and focus more on what’s important. That’s why Transamerica offers the voluntary benefits employees need to help provide financial protection against the unexpected. So when accidents happen, our accident insurance helps with out-of-pocket costs major medical insurance won’t cover — whether it’s a minor injury or something more severe.

OFFER MORE PROTECTION WITH TRANSAMERICA ACCIDENT INSURANCE

Transamerica’s supplemental accident insurance works side-by-side with major medical insurance to help cover injuries and treatments due to a covered accident. It assists with recovery costs, including those accrued from treatments such as acupuncture, chiropractic, mental health, and much more, accelerating their paths to feeling better. A flexible option that can help strengthen a benefits package, it allows you to customize the plan design at the covered condition level. This tailored approach helps you better meet the needs of each employee.

TRANSAMERICA ACCIDENT INSURANCE HIGHLIGHTS

Added benefits available, including benefits for mental health, acupuncture/chiropractic, and observation

Insurance for individuals and families

Ability to tailor the plan design at the covered condition level Can match and improve on an existing plan design

Easy payroll-deduction premiums

Streamlined billing and self-administration without the need to reconcile at the policy level

See Product Details for more information

This is a brief summary of Transamerica Accident InsuranceSM – AC11 underwritten by Transamerica Life Insurance Company (TLIC), Cedar Rapids, Iowa. TLIC is not an authorized insurer in New York. Policy Form Series TMAC11NJ-1220 and TCAC11NJ-1220. Forms and numbers may vary. Insurance may not be available in all jurisdictions. Limitations and exclusions apply. Please refer to the policy, certificate, and riders for complete details.

About Transamerica Accident Insurance

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EMPLOYEE ELIGIBILITY

To be eligible for insurance, an employee must be 18 years or older and:

Be actively employed, performing all regular duties at the place of business or another location directed by the employer

Be continuously employed and meeting the minimum hourly and time requirements for benefit eligibility. These requirements will be defined on the Life and Health Group Application and Agreement

Not be covered by any Title XIX program such as Medicaid

SPOUSE ELIGIBILITY

To be eligible for insurance, a spouse must be 18 years or older and:

Be a legally married spouse, common law marriage partner, domestic partner, or civil union partner, if legally recognized in the governing jurisdiction or as otherwise agreed upon between the employer and us

Not be hospitalized, not be confined at home under a physician’s care, or not receiving or applying to receive disability benefits from any source

Not be eligible as an insured under the policy

Not be covered by any Title XIX program such as Medicaid

CHILD ELIGIBILITY

To be eligible for insurance, a child must be under the age of 26 years and be any of the following:

A natural child

A legally adopted child or child who has been placed for adoption with the employee A stepchild or foster child

A grandchild who lives with the employee

A child for whom the employee has been appointed legal guardian A child for whom the employee is legally required to provide support

Child must also not be hospitalized, not be confined at home under a physician’s care, or not receiving or applying to receive disability benefits from any source; and not be covered by any Title XIX program such as Medicaid.

Insurance for child dependents may continue beyond the maximum age in the event of mental or physical impairment. Proof of incapacity and conditions may vary by state.

MINIMUM PARTICIPATION

At least 3 insured employees are required to establish and maintain an employer group. Other group types may require higher participation.

EVIDENCE OF INSURABILITY

Insurance is offered on a Guaranteed Issue basis. As long as the eligibility requirements are met, insurance will be issued.

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OTHER CONSIDERATIONS

This proposal is based on employer groups with 985 eligible employees only and may not be available to other group types and sizes.

A Vermont proposal needs to be generated for employees residing in Vermont if: More than 25% of employees reside in the state of Vermont; or

Face-to-face solicitation will be performed at a workplace in the state of Vermont Impacted employees should enroll in Vermont approved insurance.

Product Detai l s

COVERED BENEFITS

RateSheet

**HSA Compatible – Based on its understanding of available guidance, Transamerica Life Insurance Company views the insurance benefits shown in this proposal as compatible with High- Deductible Health Plans and Health Savings Accounts. However, there is no guarantee that the relevant authorities will agree with Transamerica’s understanding. Current guidance is not complete and is subject to change. Neither Transamerica nor its agents or representatives provide legal or tax advice. Accordingly, Transamerica encourages its customers to consult with and rely upon independent tax and legal advisors regarding their particular situations, the use of the products presented here with High-Deductible Health Plans and Health Savings Accounts, and the persons/dependents that may be insured under such plans and accounts.

Issue State: New Jersey

Rate generation date: August 4, 2023

SIC Code: 9111

Def i ni t i ons

Def i ni t i ons

The benefits described below are payable when an insured is treated for bodily injuries resulting from an accident for which benefits are payable. All benefits will be paid to the insured, unless otherwise stated or when the insured has assigned benefits. Benefits may vary by state or plan option.

INITIAL TREATMENT AND DIAGNOSIS BENEFITS

Def i ni t i ons

Each of the following Initial Treatment and Diagnosis Benefits will be payable once per insured per accident.

Def i ni t i ons

Initial Accident Treatment Benefit – A benefit will be paid if an insured receives treatment for a bodily injury. Treatment must be received within 4 days of the accident and must be provided by a physician in any of the following:

A physician’s office Hospital emergency room An urgent care center

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Ambulance Benefit – A benefit will be paid for ambulance transportation by a licensed ambulance service if, because of an accident, the insured is transferred by ambulance to the nearest hospital for treatment within 4 days of the accident.

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Laceration Benefit – A benefit will be paid if an insured receives treatment for a laceration within 4 days of the accident.

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Medical Diagnostic Imaging – A benefit will be paid if an insured undergoes one of the following due to a bodily injury:

CT (Computerized Tomography) scan MRI (Magnetic Resonance Imaging) EEG (Electroencephalogram)

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Imaging must be performed within 90 days of the accident.

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Blood, Plasma, and Platelets – A benefit will be paid if an insured requires blood, plasma, or platelets for the treatment of a bodily injury. Immunoglobulins are not covered. Treatment must be received within 14 days of the accident.

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X-Ray – A benefit will be paid if an insured undergoes an X-Ray due to a bodily injury. X-Ray’s must be performed within 4 days of the accident.

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Lab Test – A benefit will be paid if an insured undergoes a lab test due to a bodily injury. Lab tests must be performed within 4 days of the accident.

BODILY INJURY BENEFITS

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Each of the following Bodily Injury benefits will be payable once per insured per accident.

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Brain (Concussion/Traumatic Brain Injury) – A benefit will be paid if an insured is diagnosed with a concussion by a physician within 4 days of the accident.

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Dislocation or Fracture – A benefit will be paid if an insured requires correction of a dislocation or fracture by a physician. Benefit varies by the location of the dislocation or fracture. Correction can be made through an open reduction (surgical repair) or closed reduction (manipulative repair) and must be repaired by a physician within 14 days of the accident. If more than one dislocation and/or fracture is repaired, the benefit paid will be

1.5 times the larger benefit amount. Dislocations not corrected under general anesthesia will be reduced to 50% of the applicable benefit amount. Chip Fractures pay 10% of the applicable fracture benefit amount and must be diagnosed by a physician through the use of an X-Ray.

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Dental – A benefit will be paid if an insured sustains broken teeth in an accident. Treatment must be received within 180 days of the accident.

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Eye Injury – A benefit will be paid if the insured sustains eye damage in an accident. Treatment must be received from a physician within 180 days of the accident.

HOSPITALIZATION BENEFITS

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Admission Benefit – A benefit will be paid if an insured is admitted to a hospital for treatment of a bodily injury. The Admission Benefit is paid in addition to the Hospital Confinement Daily Benefit. Only one Admission Benefit is payable per insured per accident. We will only pay the Intensive Care Unit Admission Benefit if the initial admission is to the Intensive Care Unit. For all other admissions, the normal Admission Benefit will be paid.

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Daily Benefit – A benefit will be paid for each day an insured is hospital confined due to an accident. Confinement must begin within 31 days of the accident. An additional benefit will be paid for each 24-hour period the insured is confined in any of the following:

An Intensive Care Unit A Step-Down Unit

An Observation Room

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Inpatient Rehabilitation Unit – A benefit will be paid for each day an insured is confined in a rehabilitation facility following a period of hospital confinement. The benefit is not payable for the same days that the hospital confinement benefit is payable.

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Daily benefits are subject to limits shown in the Product Details.

RECOVERY SERVICES BENEFITS

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Appliance – A benefit will be paid for a medical appliance recommended by a physician as an aid in personal locomotion as the result of an accident. This benefit is not payable for prosthetic devices. Benefit is payable once per insured per accident.

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Residence and Vehicle Modification – A benefit will be paid if an insured suffers total disability due to a bodily injury within 365 days of the accident. This benefit is payable once per insured per accident. The modification must be made within 2 years from the date of the accident causing the injury.

Def i ni t i ons

The benefit will be payable for the modification to the insured’s primary residence to make the residence accessible or private passenger automobile to make it drivable or ridable only if the modification is all the following:

Made by a person or persons with experience in such modifications

Recommended by a physician or recognized organization associated with the total disability Certified by a physician that the modification is needed to accommodate the total disability

In compliance with the applicable laws or requirements for the approval by the appropriate government authorities

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Family Lodging – A benefit will be paid per day, up to a maximum of 30 days per accident, for one motel/hotel room for an immediate family member to accompany the insured if hospital confinement is within 90 days of an accident for the treatment of a bodily injury. Benefits are payable only for the same time- period the insured is hospital confined in a facility 50 or more miles from the insured’s primary residence. The local attending physician must prescribe the treatment.

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Acupuncture Care – A benefit will be paid if an insured receives acupuncture treatment on the advice of a physician due to an accident. Acupuncture treatments must begin within 180 days of the accident and be completed within 1 year after the accident.

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Chiropractic Care – A benefit will be paid if an insured receives chiropractic treatment on the advice of a physician due to an accident. Chiropractic treatments must begin within 180 days of the accident and be completed within 1 year after the accident.

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Follow-Up Treatment – A benefit will be paid if an insured first receives treatment for a bodily injury within 4 days of the accident and later requires additional treatment for the same injury. Treatments must be furnished by a physician in the physician’s office or in a hospital on an outpatient basis. Follow-up treatment must begin within 180 days of, and be completed within, the 12-month period following the later of the following dates:

The accident

Discharge from the hospital

Discharge from an extended care facility

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Mental Health Care – A benefit will be paid if an insured has received treatment for a covered accident and requires psychological or psychiatric care for a mental health condition triggered by the accident. Treatment must begin within 3 months of the covered accident.

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Pain Management – A benefit will be paid if an insured is prescribed and receives an injection administered into the spine or a nerve ablation or block for pain management due to an accident.

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Prosthetic Devices – A benefit will be paid for a prosthetic device due to a covered accident. This benefit is not payable for hearing aids, dental aids (including false teeth), eyeglasses, or for cosmetic prosthetic devices such as hair wigs. We will not pay for joint replacement, such as an artificial hip or knee. The insured must receive the prosthetic device(s) or artificial limb(s) within 24 months of the accident.

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Repair – A benefit will be paid if an insured loses or damages their existing prosthetic device or artificial limb as a result of an accident. Repair must be made within 365 days of the accident. This benefit is not payable for any of the following:

Hearing aids

Dental aids (including false teeth) Eyeglasses

Cosmetic prostheses such as hair wigs

Joint replacement such as artificial hip or knee

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Therapy Services – A benefit will be paid if, as a result of an accident, a physician advises an insured to seek treatment from any of the following:

A physical therapist

An occupational therapist

A speech therapist

Def i ni t i ons

Therapy must begin within 180 days of the accident. All treatments must be completed within 1 year after the accident.

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Transportation – A benefit will be paid for round-trip transportation if an insured requires confinement in a hospital more than 50 miles from the insured’s primary residence as the result of an accident. The local attending physician must prescribe the treatment and the treatment must not be available locally. Travel and hospital confinement must occur within 90 days of the accident.

MAJOR INJURIES

Def i ni t i ons

Each of the following Major Injuries benefits will be payable once per insured per accident.

Def i ni t i ons

Burns – A benefit will be paid if an insured suffers burns due to an accident. If multiple burns exist, the highest benefit for the most severe burn will be paid. When applicable, the Skin Graft benefit will be paid in addition to the burn benefit. Burns must be treated by a physician within 4 days of the accident.

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Coma – A benefit will be paid if an insured suffers a coma due to an accident. The benefit amount varies by whether the coma was induced or non-induced. The coma must last for a minimum of 10 consecutive days before this benefit is payable.

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Paralysis – A benefit will be paid if an insured becomes paralyzed due to an accident. Paralysis must last a minimum of 30 consecutive days before this benefit is payable.

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Major Surgery – A benefit will be paid if an insured undergoes an open abdominal, cranial, or thoracic surgery performed by a physician within 1 year of the accident. Laparoscopic procedures are excluded.

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Exploratory Surgery – A benefit will be paid if an insured undergoes minimally invasive surgery performed by a physician within 1 year of the accident using manual and instrumental means of investigating an area of the body suspected of disease when a specific diagnosis is not possible through noninvasive or simple biopsy techniques. Laparoscopic procedures are included.

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Surgery on Tendons, Ligaments, Rotator Cuffs – A benefit will be paid if, as a result of an accident, an insured undergoes surgery for tendons, ligaments, or rotator cuffs that are detached, torn, ruptured, or severed.

Surgery must be performed by a physician within 1 year of the accident.

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Surgery on Ruptured Discs or Torn Knee Cartilage – A benefit will be paid if an insured undergoes surgery for a disc in the spine that is ruptured or knee cartilage that is torn. Surgery must be performed by a physician within 1 year of the accident.

ACCIDENTAL DEATH BENEFITS

Def i ni t i ons

Benefits for the loss of life resulting from bodily injuries resulting from an accident. Accidental death must be independent of disease or bodily infirmity or any other cause, other than an accident.

Def i ni t i ons

Accidental Death – A benefit will be paid for the insured’s accidental death. The accident must occur while insurance is in force. Such accidental death must occur within 12 months of the accident. The benefit will be paid to the beneficiary.

Def i ni t i ons

Only one Accidental Death benefit will be paid per insured, the highest applicable benefit, as described below:

Automobile Accident – Accidental death resulting from an accident that occurs while the insured is driving or riding as a passenger in an automobile. Automobile is defined as a four-wheeled private passenger motor vehicle licensed for use on public highways and is not being used to transport passengers for hire. The Automobile Accident benefit will not be payable if the insured is the driver of the automobile and does not hold a current and valid driver’s license.

Common Carrier Accident – Accidental death resulting from an accident that occurs while the insured was riding as a fare-paying passenger on public transportation. Public Transportation is defined as a public passenger conveyance operated by a licensed common carrier for the transportation of the general public for a fare and operating on regularly scheduled passenger routes with a definite schedule of departures and arrival times.

Common carrier vehicles are limited to commercial airplanes, trains, buses, trolleys, subways, ferries, and boats that operate on a regularly scheduled basis between predetermined points or cities. Taxis, limousines, and privately chartered vehicles are not common carriers.

Other Accidental Death – Accidental death resulting from any other bodily injury other than Automobile Accident or Common Carrier Accident.

Def i ni t i ons

Transportation of Remains – A benefit will be paid if, as a result of an accident, the insured dies more than 200 miles from their primary residence and expenses are incurred to transport the insured’s body to a mortuary near their primary place of residence. This benefit is payable once per insured and only if the Accidental Death Benefit is payable. This benefit will be paid to the person incurring the expense.

DISMEMBERMENT BENEFITS

Def i ni t i ons

A benefit will be paid if an insured suffers a dismemberment due to an accident. Dismemberment must occur within 12 months of the accident. A dismemberment is defined as a bodily injury that is independent of disease or bodily infirmity and results in the complete severance of a body extremity or the complete loss of sight, speech, or hearing.

SURVIVOR BENEFITS

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The following benefits are paid to the survivor upon the accidental death of an insured. For purposes of these benefits, Survivor is defined as any of the following:

Surviving insured – if the spouse is deceased from the accidental death Surviving spouse – if the insured is deceased from the accidental death

Legally appointed guardian of each surviving child – if both the insured and spouse are deceased from the accidental death

Def i ni t i ons

The survivor does not need to be insured under this certificate to receive survivor benefits.

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Career Enrichment Benefit – A benefit will be paid if the survivor enrolls in a professional or trade training program on a full-time basis within 24 months of the accidental death. The training program must be for the purpose of obtaining an independent source of income or enriching the survivor’s ability to earn a living. The training program must be at an accredited college, university, a 2-year college, vocational, or trade school.

This benefit will be paid each year for up to 4 years while the survivor remains enrolled in a training program. Satisfactory proof of enrollment must be provided annually. If there is no survivor, a one-time benefit of $200 will be paid to the beneficiary.

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Child Care Center Benefit – A benefit will be paid when the following conditions are met:

The surviving child must be within the ages of newborn through 12 years

The survivor pays a child care center for day care, within 90 calendar days after the date of the accidental death

The day care is necessary in order for the survivor to work or to obtain training for work

Def i ni t i ons

This benefit will be paid each year for up to 4 years while the surviving child is enrolled in a child care center, provided the child remains enrolled in a child care center during that time. This benefit will be paid in equal installments over the 4-year period. Separate benefits will be paid for each surviving child who meets the requirements for this benefit. Satisfactory proof of enrollment must be provided annually. If there is no surviving child between the ages of newborn through 12 years, a one-time benefit of $200 will be paid to the beneficiary.

Def i ni t i ons

For purposes of this benefit, the child care center must be an appropriately licensed facility or home that meets all of the following conditions:

Provides supervision for more than 6 persons (other than persons who reside there) under the age of 13 years for less than 24 hours per day

Receives a payment for providing dependent care services

Has a Taxpayer Identification Number

Def i ni t i ons

Child Education Benefit – A benefit will be paid when the following conditions are met: The surviving child must be within the ages of 17 years through 21 years

The surviving child must be enrolled or must enroll within 2 years of the accidental death, as a regular, full time student at an accredited college, university, 2-year college, vocational, or trade school

Def i ni t i ons

This benefit will be paid each year for up to 4 years while the surviving child is enrolled in school. This benefit will continue to be paid only while the surviving child remains a full-time student. This benefit will be paid in equal installments over the 4-year period. Separate benefits will be paid for each surviving child who meets the requirements for this benefit. Satisfactory proof of student status must be provided annually. If there is no surviving child between the ages of 17 years through 21 years, a one-time benefit of $200 will be paid to the beneficiary.

OFFER EXTRA BENEFITS — AND ADDED REASSURANCE

When employees are able to protect their finances and loved ones, they’re free to focus on what’s important. But unexpected medical costs following a hospital stay can be financially — and emotionally — devastating.

Transamerica’s Hospital Select II hospital indemnity insurance gives you one more valuable option for your benefits package – and helps your employees know that a hospital stay won’t have to jeopardize their family’s financial future.

HOW HOSPITAL SELECT II WORKS

A supplement to traditional medical insurance, Hospital Select II hospital indemnity insurance pays a cash benefit that can be used to help cover deductibles, lost income due to missed work, and other expenses that can come up because of hospitalization. You can also add a number of additional riders to provide additional benefits.

HOSPITAL SELECT II HIGHLIGHTS

Benefits for full-time, part-time, hourly, seasonal, and temporary workers and their eligible family members

No co-insurance, co-pays, waiting period, or deductibles No health questions, exams, or blood tests

Payroll-deducted premiums starting at $10 per month for employee insurance benefits Streamlined billing and self-administration without the need to reconcile at the policy level Benefits paid in addition to any other insurance the insured may have

No pre-existing condition limitations

See Product Details for more details

This is a brief summary of Hospital Select® II hospital indemnity insurance policy underwritten by Transamerica Life Insurance Company (TLIC), Cedar Rapids, Iowa. TLIC is not an authorized insurer in New York. Policy Form Series TMHI10NJ-0118 and TCHI10NJ-0118. Forms and numbers may vary. Insurance may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate, and riders for complete details.(H)

THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES.

About Hospital Select II Hospital Indemnity Insurance

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EMPLOYEE ELIGIBILITY U nderw ri t i ngOf f erandEl i gi bi l i ty

To be eligible for insurance, an employee must:

Be at least 18 years old

Not be covered by any Title XIX program such as Medicaid

Be on active service, performing in the usual manner all of the regular duties of his or her occupation at one of the places of business where he or she normally works or at some location directed by the employer; and be continuously employed for the amount of time and working the minimum number of hours per week as you require to be eligible for benefits. These requirements will be defined on the Life and Health Group Application and Agreement.

SPOUSE ELIGIBILITY U nderw ri t i ngOf f erandEl i gi bi l i ty

To be eligible for insurance, a spouse must:

Be at least 18 years old

Be a person who is legally married to the Insured; the Insured’s New Jersey civil union partner; or the Insured’s civil union partner relationship entered into outside of New Jersey which provides substantially all of the rights and benefits of marriage and is valid under the laws of the jurisdiction in which the civil union relationship was entered

Not be disabled (must be able to perform the majority of the normal activities of a person of like age in good health) Not be covered by any Title XIX program such as Medicaid

CHILD ELIGIBILITY U nderw ri t i ngOf f erandEl i gi bi l i ty

A child of yours by blood, marriage, or civil union who:

Is under the age of 30

Is unmarried or unpartnered

Has no dependent of his or her own

Is a resident of the State of New Jersey or is enrolled as a full-time student at an accredited public or private institution of higher education

U nderw ri t i ngOf f erandEl i gi bi l i ty

If applicable, child will also include any children of your other adult dependent in the same manner as a stepchild.

U nderw ri t i ngOf f erandEl i gi bi l i ty

If an insured has reached age 30, but is incapable of self-support because of mental or physical impairment, we will continue the child’s insurance under the following conditions:

1. The child must be incapacitated

2. We must receive proof of incapacity within 31 days after insurance would otherwise terminate

3. We may require additional proof of such incapacity from time to time, but not more often than once a year after the two-year period following the date the child attains age 30

4. Your insurance must remain in force

MINIMUM PARTICIPATION U nderw ri t i ngOf f erandEl i gi bi l i ty

At least 3 eligible employee applications are required to establish and maintain an employer group with monthly list bill administration, other group types and administrative requirements may require higher participation.

EVIDENCE OF INSURABILITY U nderw ri t i ngOf f erandEl i gi bi l i ty

Insurance is Guaranteed Issue when an applicant first becomes eligible for insurance.

U nderw ri t i ngOf f erandEl i gi bi l i ty

Insurance applied for at a later date will be considered a Late Enrollee. Late Enrollee applications are underwritten on an accept/reject basis. If an employee answers “yes” to the questions on the application, we will decline the application for all

persons for whom insurance is being requested. If there is a “yes” answer to the questions for the spouse, the spouse only will be declined insurance. If there is a “yes” answer to the questions for a dependent child, that one child will be declined insurance.

OTHER CONSIDERATIONS U nderw ri t i ngOf f erandEl i gi bi l i ty

Please be aware of the following:

This proposal is based on employer groups with 985 eligible employees only and may not be available to other group types or sizes

Please note that at this time we are only able to offer insurance to New Mexico residents if there are one hundred

(100) or fewer eligible employees residing in New Mexico. If there are more than one hundred (100) eligible employees residing in New Mexico currently, or at any time in the future, we are not able to offer insurance to those individuals. We will rely on each employer to alert Transamerica if there are more than one hundred (100) eligible employees residing in New Mexico currently, or at any time in the future.

U nderw ri t i ngOf f erandEl i gi bi l i ty

We are also not able to offer insurance to any members of non-employer groups that are residing in New Mexico. For Massachusetts Residents: This product DOES NOT MEET CREDITABLE COVERAGE STANDARDS and WILL NOT SATISFY the Massachusetts individual mandate that you have health insurance

A Vermont proposal needs to be generated for employees residing in Vermont if: More than 25% of employees reside in the state of Vermont; or

Face-to-face solicitation will be performed at a workplace in the state of Vermont

U nderw ri t i ngOf f erandEl i gi bi l i ty

Impacted employees should enroll in Vermont approved insurance

Product Detai l s

Hospital Select II hospital indemnity insurance pays employees a cash benefit to help cover costs associated with a hospital stay. Hospital Select II is a voluntary policy intended to supplement the major medical insurance in your benefits package. The following benefits are included in your plan option(s). Unless otherwise noted, all benefits and maximums are per insured person.

Product Detai l s

The illustrated rates DO NOT contain a pre-existing condition limitation.

The above rates are quoted for groups with 985 eligible lives. Should this plan design sell and the submitted group size is different, rates may be different. Issue State: New Jersey

Rate generation date: August 2, 2023

SIC Code: 9111

** HSA Compatible - Based on its understanding of available guidance, Transamerica Life Insurance Company views the insurance benefits shown in this proposal as compatible with High- Deductible Health Plans and Health Savings Accounts. However, there is no guarantee that the relevant authorities will agree with Transamerica's understanding. Current guidance is not complete and is subject to change. Neither Transamerica nor its agents or representatives provide legal or tax advice. Accordingly, Transamerica encourages its customers to consult with and rely upon independent tax and legal advisors regarding their particular situations, the use of the products presented here with High-Deductible Health Plans and Health Savings Accounts, and the persons/dependents that may be insured under such plans and accounts.

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Limitations and Exclusions

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Limitations and exclusions may vary by state or plan option.

WORKER’S COMPENSATION EXCLUSION FOR OFF-THE-JOB COVERAGE

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No benefits are provided for injuries that occur in the workplace or during the course of any employment for pay, benefit or profit.

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We will not pay benefits for any accident that is caused by or occurs as a result of any of the following:

Driving any taxi (including ride share programs such as Uber and Lyft) for wage, compensation, or profit Mountaineering, parachuting, or hang gliding

Voluntarily taking, administering, absorbing, or inhaling poison, gas, or fumes Alcoholism or drug addiction

Participating in any sport or sporting activity for wage, compensation, profit, or racing any type of vehicle in an organized event

Traveling in or descending from any vehicle or device for aerial navigation, unless as a fare paying passenger on a scheduled or a charter flight operated by a scheduled airline

War, or any act of war, whether declared or undeclared

Participating in any activity or event, including the operation of a vehicle, while intoxicated or under the influence according to the laws of the jurisdiction in which the accident occurred

Actively participating in a riot, civil commotion, civil disobedience, or unlawful assembly

Committing, attempting to commit, or voluntarily taking part in a felony or assault, or engaging in an illegal occupation

Intentionally self-inflicting a bodily injury or attempting suicide, while sane or insane

Any loss incurred while on active duty status in the armed forces. If you notify us of such active duty, we will refund any premiums paid for any period for which no insurance is provided as a result of this exception

CONVERSION OPTION

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If an employee loses eligibility for this insurance for any reason other than nonpayment of premium, they will have the option to convert this group insurance to a policy we are issuing for the purpose of conversions. The premium for the converted policy will be based on resident state, age, and class of risk at the time of conversion and the type and amount of insurance provided. Conversion option is not available for the insured’s dependents without the insured.

TERMINATION OF INSURANCE

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Employee insurance will terminate on the earliest of: The date the group master policy terminates

The date the employee ceases to be eligible for insurance

The date of the employee's death

The premium due date on which we fail to receive the employee's premium, subject to the grace period provision

The date we receive the employee's request to terminate the insurance, or the effective date of termination requested, if later

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Dependent insurance will terminate on the earliest of:

Limitations and Exclusions

The date the employee's insurance terminates

The premium due date on which we fail to receive the employee's premium from the employer, subject to the grace period provision

The date the dependent no longer meets the definition of dependent The date of the dependent’s death

The date the group master policy is modified to exclude dependent insurance

The date we receive the employee's request to terminate their dependent insurance, or the effective date of termination requested, if later

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We may terminate the insurance of any insured person who submits a fraudulent claim.

TERMINATION OF THE GROUP MASTER POLICY

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The group master policy will terminate at the earliest of the following:

If the employer submits a 60-day advance written request to us to terminate the policy, the policy will terminate on the date specified in the request

If we give a 60-day advance written notice to the employer that we intend to terminate the policy, the policy will terminate on the date specified in the notice

If any premium payable by the employer is not paid within its grace period, the policy will terminate on the day after the end of the grace period

The policy will terminate on the 32nd day after we have given the employer written notice of our intent to terminate if the employer:

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1. Fails to comply with any terms of the policy or the policyholder application

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2. Fails to fulfill any obligations or duties under or pertaining to the insurance

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3. Fails to comply with or cooperate with us in satisfying the requirements of any applicable law or regulation pertaining to the insurance

OTHER INSURANCE WITH US

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If an insured has more than one accident policy, certificate, or similar insurance with us, only one, chosen by the insured or insured’s estate, will be effective. We will refund all premiums paid for all other such insurance from the date of the duplication, less any benefits paid from such date.

HOSPITAL SELECT ®II

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Limitations and Exclusions

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HOSPITAL SELECT II

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Confinement for the same or related condition within 90 days of discharge will be treated as a continuation of the prior confinement. Successive confinements separated by more than 90 days will be treated as a new and separate confinement.

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No benefits under this contract will be payable as the result of the following:

Suicide or attempted suicide Intentionally self-inflicted injury

Rehabilitative care and treatment or rest care

Immunization shots and routine examinations such as: physical examinations, mammograms, pap smears, immunizations, flexible sigmoidoscopy, prostate-specific antigen tests, and blood screenings Routine newborn care

Hospital confinement of a newborn child following the child’s birth, unless the newborn child is being treated for accidental injury or sickness

An insured person’s abortion, except for medically necessary abortions performed to save the mother’s life

Treatment of mental or emotional disorder Treatment of alcoholism or drug addiction

An insured being intoxicated or under the influence of any narcotic unless administered on the advice of a physician

Dental care or treatment, except for such care or treatment due to accidental injury to sound, natural teeth within 12 months of the accident and except for dental care or treatment necessary due to congenital disease or anomaly

Sex change, reversal of tubal ligation, or reversal of vasectomy

Artificial insemination, in vitro fertilization, and test tube fertilization, including any related testing, medications, or physician’s services, unless required by law

An insured’s commission of or attempt to commit a felony or the insured’s engagement in an illegal occupation

Aviation except as a fare-paying passenger on a regularly scheduled airline

Any loss incurred on active duty status in the armed forces. (If you notify us of such active duty, we will refund any premiums paid for any period for which no insurance is provided as a result of this exception.)

Involvement in any war or act of war, whether declared or undeclared participation in a riot or insurrection

CONVERSION OPTION

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If an employee loses eligibility for this insurance for any reason other than fraud or nonpayment of premiums or termination of the group master policy, they will have the option to convert this group insurance to an individual hospital indemnity policy by submitting an application and the first month’s premium to us within 31 days after loss of eligibility. We will bill the employee directly once we receive notification to continue insurance.

TERMINATION OF INSURANCE

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The insurance terminates on the earliest of:

The insured’s death

The premium due date when we fail to receive a premium, subject to the grace period

The date the employee requests the insurance to be canceled, or the date the request is received, whichever is later

The date the policy terminates

The date the insured ceases to be eligible for insurance

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Dependent insurance ends on the earliest of:

The date the insured employee’s insurance terminates

The date the dependent no longer meets the definition of a dependent The date of the dependent’s death

The premium due date when we fail to receive a premium, subject to the grace period

The date the employee requests the dependent’s insurance to be canceled, or the date the request is received, whichever is later

The date the policy is modified so as to exclude dependent insurance

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The insurance company has the right to terminate the insurance of any insured who submits a fraudulent claim.

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Termination will not impact any claim which begins before the date of termination.

TERMINATION OF THE GROUP MASTER POLICY

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This policy will end on the earliest of the following events:

If the policyholder submits an advance written request to us to terminate this policy, this policy will terminate on the date specified in that request

If we give a 60-day advance written notice to the policyholder that we intend to terminate this policy, this policy will terminate on the date specified in that notice

If any premium payable by the policyholder is not paid within its grace period, this policy will terminate on the day after the end of the grace period

If the policyholder fails to comply with any terms of this policy or the policyholder application; fails to fulfill any obligations or duties under or pertaining to this insurance; or fails to comply with or cooperate with us in satisfying the requirements of any applicable law or regulation pertaining to this insurance; this policy will terminate on the 32nd day after we have given the policyholder written notice of our intent to terminate

OTHER INSURANCE WITH US

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An employee can only have one hospital indemnity policy or certificate with us. If a person already has hospital indemnity insurance with us, such person is not eligible to apply for this insurance.

GroupBenef i tsDi scl osurePol i cy

Transamerica Employee Benefits (TEB) is a unit of Transamerica Life Insurance Company and Transamerica Financial Life Insurance Company. TEB markets and administers voluntary insurance benefits through licensed insurance agents. These agents are typically appointed to sell our products, and products of other providers, and receive various forms of compensation from us for the services provided. We believe our compensation arrangements with our agents are conducted with honesty, fairness, and integrity. In addition, we realize that having trusted relationships between our agents and our customers is essential to all involved. To ensure this trust continues and to address any concerns within the industry, we have outlined our policy on agent compensation disclosure.

TEB’s policy supports transparency and full disclosure of agent compensation to our customers and prospective customers. In addition, we have put controls in place to facilitate this disclosure and obligate our agents to disclose compensation information to customers: 1) when asked by a customer;

2) when receiving both a fee from the customer and compensation from TEB; and 3) when otherwise required by law. Agents must comply with all applicable laws in the sale of TEB products, including any pertaining to the disclosure of compensation information.

Up-to-date information regarding our compensation practices can be found in the Disclosures section of our website at tebcs.com.

EB3 253828 V 05/23

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