Long Term Care Insurance Policy, Page 4

POLICY SCHEDULE

This Policy Schedule provides You with specific information about the benefits You selected
and how much We will pay.

Coverage Limits:

Elimination Period
Benefit Period
Policy Limit
Long-Term Care Benefit Amount
Respite Care Benefit Amount
Care Advisory Services Benefit Amount
International Coverage Benefit Amount
Accident Benefit Amount
Cash Benefit Amount
Home Modification Lifetime Benefit Amount
Compound Inflation Coverage
Base Policy Premium

Optional Benefits Selected and Included in this Policy:

SharedCare Benefit
Survivorship & Waiver of Premium Benefit
Waiver of the Home Care Elimination Period
Cash Benefit
Return of Premium Benefit upon Death
Restoration of Benefits
Nonforfeiture Benefit

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