Optional Accidental Death & Dismemberment Insurance Benefit Highlights For employees of: HARTFORD FIRE INSURANCE COMPANY What is Accidental Optional Accidental Death & Dismemberment Insurance is coverage that you pay for. Death & Dismemberment Accidental Death & Dismemberment Insurance pays your beneficiary (please see Insurance? below) a death benefit if you die due to a covered accident while you are insured. It also pays you a benefit for certain accidental losses. Death benefits are paid in addition to any life insurance benefits. Accidental Death & Dismemberment Insurance pays benefits for accidental loss of limbs, thumb and index finger, speech, hearing, and sight. Accidental Death & Dismemberment Insurance covers losses that occur away from work or at work. Benefits are paid regardless of any Worker’s Compensation benefits you collect. This highlight sheet is an overview of your Accidental Death & Dismemberment Insurance. Why do I need The need to protect yourself and your family from the financial consequences of a Accidental Death & severe injury, paralysis or death resulting from an accident at or outside of work is real. Dismemberment Accident Insurance from The Hartford shields you and your family from income loss Insurance? whether at home or away from home. What does Accidental You may receive benefits due to certain losses or death from an accident. The Death & covered losses or death can occur up to 365 days after that accident. The policy Dismemberment pays for: Insurance pay for? 100% of the amount of coverage you purchase in the event of accidental loss of life, or speech and hearing in both ears. One-half (50%) for accidental loss of one hand or foot, sight of one eye, or speech or hearing in both ears. One-quarter (25%) for accidental loss of thumb and index finger of the same hand. Additional losses are covered, as outlined in the Summary Plan Description located on Fidelity's website (www.netbenefits.fidelity.com). Your total benefit for all losses due to the same accident will not be more than 100% of the amount of coverage you purchase. What optional benefits Adaptive Home and Vehicle Benefit Day Care Benefit has my Employer Child Education Benefit Seat Belt & Air Bag selected as part of my Accidental Death & Rehabilitation Benefit Repatriation Benefit Dismemberment Insurance? The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries including issuing company Hartford Life and Accident Insurance Company. Home Office is Hartford, CT.. Hartford Fire Insurance Company AD&D BHS Creation Date: 09/14/2016 Page 1 of 4 Version 11/12 When am I eligible? You are eligible if you are an active employee and citizen or legal resident of the United States, who works on a regularly scheduled basis for at least 20 hours or more per week. How do I enroll? You are required to enroll for coverage. You can enroll via NetBenefits (www.netbenefits.com/thehartford) or by calling The Harford HR Service Center at 1.877.HR.AT.WORK. If you do not enroll within 31 days after the date you first become eligible to do so you may only enroll: (1) during an Annual Enrollment Period; or (2) within 31 days of a Change in Family Status. The Annual Enrollment Period is determined by The Hartford on a yearly basis. When does my Your coverage will start on the date you become eligible, if you enroll on or before coverage start? that date or within 31 days after the date you become eligible. You must be actively at work on the day your coverage takes effect. Otherwise, the effective date of your coverage will be deferred until you return to work. How much Accidental You can purchase Accidental Death & Dismemberment Insurance in increments of Death & 1 times your Annual Frozen Benefits Base Salary up to 5 times your Annual Frozen Dismemberment Benefits Base Salary. The maximum amount you can purchase cannot be more than Insurance can I the lesser of 5 times your Annual Frozen Benefits Base Salary or $1,225,000. purchase? Annual Frozen Benefits Base Salary means your Earnings, rounded to the next higher $1,000 if not an even multiple thereof, that was in effect on a date selected by The Hartford. This date will be prior to the current plan year. If you were not an employee on the date selected by The Hartford as described previously, Annual Frozen Benefits Base Salary means your Earnings on your most recent date of hire, rounded to the next higher $1,000 if not an even multiple thereof. If there is any type of change in Your Annual Frozen Benefits Base Salary which: (1) decreases an amount of coverage or deletes, limits or restricts the availability of a benefit or provision, then that de-crease, deletion, limitation or restriction will be effective on the January 1st following the date the change in Annual Frozen Benefits Base Salary is effective; (2) increases an amount of coverage or adds, improves or increases availability of a benefit or provision, then that increase, addition or improvement will be effective on the January 1st following the date the change in Annual Frozen Benefits Base Salary is effective, subject to application of the Deferred Effective Date provision and Our approval where Evidence of Good Health is required. Do I have to provide No Evidence of Good Health is required. You are guaranteed the amount of coverage medical information to that you select, subject to maximum amounts as defined under the plan. receive coverage? The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries including issuing company Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. Hartford Fire Insurance Company AD&D BHS Creation Date: 09/14/2016 Page 2 of 4 Version 11/12 What is a beneficiary? Your beneficiary is the person (or persons) or legal entity (entities) who receives a benefit payment if you die while you are covered by the policy. You must select your beneficiary when you complete your enrollment application; your selection is legally Income Protectionbinding. You are automatically the beneficiary for any dependent coverage and for any AD&D losses other than life. Are any resources Life Conversations is an innovative personal planning program – providing available for employees employees on-line and 24/7 advisor-supported access to a suite of tools and services and beneficiaries? to guide them through major life decisions. Life Conversations is available exclusively to employees covered under a basic and/or supplemental group life insurance from The Hartford. These services are available at no additional cost and consist of current value added services: Beneficiary Assist, Estate Guidance and Travel Assistance. Accidental Death & You may elect Family Voluntary Accidental Death & Dismemberment Insurance for Dismemberment your dependents. If you elect Family coverage, the Principal Sum for your covered Insurance for your dependents will be a percentage of your coverage, as outlined below: dependents The amount of Principal Sum for each of your Spouse/ Each covered dependents is determined below as a Domestic Child** percent of your Principal Sum. You with your:* Partner Spouse/Domestic Partner only 50% 0% Spouse/Domestic Partner & Children 40% 10% Children only 0% 15% * As determined on the date of accident. **The Principal Sum for any one Covered Child is subject to a minimum of $5,000. The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries including issuing company Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. Hartford Fire Insurance Company AD&D BHS Creation Date: 09/14/2016 Page 3 of 4 Version 11/12 Important Details As is standard with most insurance, this voluntary accidental death & dismemberment insurance coverage includes limitations and exclusions. Voluntary accidental death & dismemberment insurance does not cover lossesIncome caused by orProtection contributed by: sickness; disease; or any treatment for either; taking prescription or illegal drugs unless any infection, except certain ones caused by an prescribed for or administered by a licensed accidental cut or wound; physician; intentionally self-inflicted injury, suicide or suicide injury sustained while committing or attempting to attempt; commit a felony; war or act of war, whether declared or not; injury sustained while driving while intoxicated injury sustained while in the armed forces of any country or international authority; Other exclusions may apply depending upon the terms of your policy and other requirements. This benefit highlights sheet is an overview of the general purposes of the voluntary accidental death & dismemberment insurance being offered and is provided for illustrative purposes only and is not a contract. It in no way changes or affects the policy as actually issued. Only the insurance policy issued to the policyholder (your employer) can fully describe all of the provisions, terms, conditions, limitations and exclusions of your insurance coverage. In the event of any difference between the benefit highlights sheet and the policy, the terms of the insurance policy apply. The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries including issuing company Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. Hartford Fire Insurance Company AD&D BHS Creation Date: 09/14/2016 Page 4 of 4 Version 11/12 .