Anaheim City Council
September 22, 2026

AGREEMENT
THIS AGREEMENT, dated for purposes of identification only this ______ day of______________, is made and entered into by and between the CITY OF ANAHEIM, a municipal corporation, hereinafter
referred to as "ANAHEIM,"
A
N
D
STANDARD INSURANCE COMPANY, an Oregon corporation, hereinafter referred to as “CONSULTANT.”
W I T N E S S E T H:

WHEREAS, ANAHEIM has established Life Insurance, Accidental Death and Dismemberment (“AD&D”), and Disability Insurance benefit plans for the benefit of its employees; and
WHEREAS, such benefit plans are funded through a combination of ANAHEIM contributions and employee contributions, as applicable; and WHEREAS, ANAHEIM is in need of a provider to insure and administer such benefit plans, including disability benefits, leave administration, and absence management services, including administration under the Americans with Disabilities Act (“ADA”); and WHEREAS CONSULTANT is a nationally recognized leader in providing and administering such benefit plans and related absence management services; and WHEREAS ANAHEIM issued a Request for Proposals (“RFP”) for such services, and CONSULTANT submitted a proposal that was selected by ANAHEIM; and WHEREAS, CONSULTANT is qualified to perform such services and is willing to do so upon terms and conditions set forth herein.
2 NOW, THEREFORE, FOR AND IN CONSIDERATION OF THE MUTUAL

PROMISES, COVENANTS AND CONDITIONS HEREIN CONTAINED, THE PARTIES HERETO AGREE AND FOLLOWS:

1. SERVICES TO BE PROVIDED
CONSULTANT agrees to provide the following benefits and services for ANAHEIM employees in line with the terms and conditions and the rates in its proposal attached hereto as Exhibit A and Performance Guarantees set forth in Exhibit B.

A. SHORT TERM DISABILITY ADMINISTRATION
CONSULTANT agrees to administer ANAHEIM’s self-funded Short-Term Disability Group Benefit Plans (the “PLAN”). The PLAN includes the Group Benefit Plan for Police Association Employees, the Group Benefit Plan for Fire Safety Employees, and the Group Benefit Plan for All Other Eligible Active Employees Excluding Police Association and Fire Safety Employees. In performing these services, CONSULTANT shall provide claim forms and the means for telephonic and online claims reporting and shall review and determine eligibility for all submitted claims in accordance with the applicable Plan Documents. CONSULTANT shall approve or deny such claims as appropriate, issue benefits payments in accordance with the terms of the PLAN, administer claim appeals, and provide related claims administration and customer support services as described in Exhibits A and C.

B. LONG TERM DISABILITY INSURANCE AND ADMINISTRATION
CONSULTANT agrees to provide fully insured Long-Term Disability Insurance to eligible employees, and to administer such benefit in accordance with the applicable insurance policy and certificates which are expressly made a part of Exhibit C and this Agreement.

CONSULTANT shall provide claim forms and the means for telephonic and online claim reporting, review and determine eligibility for submitted claims, approve and deny claims as appropriate, issue benefit payment, administer claim appeals, and provide related claims administration and customer support services as described in the group long term disability insurance policy that CONSULTANT issued to the City and is made a part of Exhibit C and this Agreement.
3 C. LIFE AND ACCIDENTIAL DEATH AND DISMEMBERSHIP

INSURANCE AND ADMINISTRATION
CONSULTANT agrees to provide Group Life Insurance and Accidental Death and Dismemberment (“AD&D”) Insurance for eligible employees, and where applicable, dependent life insurance coverage as outlined in the group life and AD&D insurance policy and certificates issued to the City and expressly made a part of this Agreement and Exhibit C. CONSULTANT shall administer these benefits, including enrollment support, beneficiary administration, evidence of insurability processing, claims administration, portability and conversion services, and such other administrative services consistent with the group life and AD&D insurance policy and certificates issued to the City.

D. ABSENCE MANAGEMENT SERVICES
CONSULTANT agrees to provide Absence Management Services to ANAHEIM, including administration of employee leaves in accordance with applicable federal and state laws, City Personnel Rules, Memoranda of Understanding (“MOUs”), City Administrative Regulations, applicable City leave policies, and the Scope of Services described in Exhibit A. Such services shall include, but not be limited to, administration of Family and Medical Leave Act leave (“FMLA”), California Family Rights Act (“CFRA”), Pregnancy Disability Leave (“PDL”), and other applicable statutory and City-administered leave programs. CONSULTANT shall also provide ADA case management and administrative support services, including coordination of the interactive process, as described in Exhibit C, recognizing that final decisions remain the responsibility of ANAHEIM.

2. TERM OF AGREEMENT
The Agreement shall be in effect from the Effective Date of this Agreement for three (3) years or until it is terminated, pursuant to the provisions of Section 13 below.

3. COMPENSATION
ANAHEIM shall pay CONSULTANT for services rendered pursuant to this Agreement the rates set forth in Exhibit A. Such rates are inclusive of all expenses which may be 4 incurred by CONSULTANT. The rates set forth in Exhibit A will be in effect for the three (3) year term of this Agreement.

4. PERFORMANCE GUARANTEES
CONSULTANT shall perform the services under this agreement in accordance with the Performance Guarantees attached as Exhibit B. CONSULTANT shall report its performance against the Performance Guarantees in accordance with the reporting requirements set forth in Exhibit B. If CONSULTANT fails to satisfy any applicable Performance Guarantee, CONSULTANT shall provide corresponding performance credit described in Exhibit B.

5. INDEPENDENT CONTRACTOR
CONSULTANT is at all times an independent contractor pursuant to this Agreement and shall not, in any way, be considered to be an officer, agent or employee of ANAHEIM.

6. INDEMNIFICATION
As respects acts, errors or omissions in the performance of professional services, CONSULTANT agrees to indemnify and hold harmless ANAHEIM, its officials, officers, and employees from and against any and all claims, losses, damages, defense costs, or liability, of any kind or nature directly arising out of the negligent acts, errors or omissions of the CONSULTANT or any SUB-AGENT in the performance of his professional services under this Agreement.

As respects all acts or omissions which do not arise directly out of the performance of professional services, including but not limited to those acts, errors or omissions typically covered by general and automobile liability insurance, CONSULTANT agrees to indemnify and defend (at ANAHEIM's option), and hold harmless ANAHEIM, its officials, officers, employees, agents and representatives from and against any and all claims, losses, demands, defense costs, liability, of any kind or nature (collectively referred to hereinafter as “Claims”), arising out of or in connection with CONSULTANT's (or CONSULTANT's AGENT or SUB-AGENT, if any) acts, errors, omissions, or work, relative to this Agreement; except for those Claims that arise out of the sole negligence or willful misconduct of ANAHEIM. 5 The obligations set forth in this indemnification provision (i) shall be in effect without regard to whether or not ANAHEIM, CONSULTANT, or any other person maintains or fails to maintain, insurance coverage, or a self-insurance program, for any such Claims; and (ii) shall survive the termination of this Agreement.

7. INSURANCE
Without limiting ANAHEIM’s right to indemnification, it is agreed that CONSULTANT shall secure, prior to commencing any activities under this Agreement, and maintain during the term of this Agreement, insurance coverage as follows:

Workers' Compensation Insurance as required by law and Employers' Liability Insurance in an amount not less than $1,000,000. This coverage requires a Waiver of Subrogation Endorsement.

Commercial General Liability Insurance, including coverage for Premises and Operations, Contractual Liability, Personal Injury Liability, Products/Completed Operations Liability, as well as Independent Contractor’s Liability where appropriate, in an amount not less than $2,000,000 per occurrence, $4,000,000 annual aggregate. Such insurance shall be written on a primary basis but may include a deductible or self-insured retention of more than $10,000 per occurrence, provided that such deductible or self-insured retention is disclosed to ANAHEIM, in writing, at the inception of this Agreement. This coverage requires a Waiver of Subrogation Endorsement.

Commercial Automobile Liability Coverage as required by California law, including - as applicable - owned, non-owned, and hired autos, in an amount not less than $2,000,000 per occurrence, combined single limit. This coverage requires a Waiver of Subrogation Endorsement.

Professional Liability Insurance, inclusive of Cyber Liability Insurance (where required) in an amount not less than $2,000,000. Such insurance shall be written on a primary basis but may include a deductible or self-insured retention of more than $10,000 per occurrence, provided that such deductible or self-insured retention is disclosed to ANAHEIM, in 6 writing, at the inception of this Agreement. Any required coverage written with primary and excess layers to satisfy the minimum requirements of this Agreement must be submitted for approval by ANAHEIM’s Risk Manager prior to the inception of the final Agreement.

CONSULTANT is responsible for the satisfaction of any applicable deductible or self-insured retention obligation.

CONSULTANT agrees that this insurance shall not be voluntarily cancelled by CONSULTANT or limited in scope or coverage by CONSULTANT until after thirty (30) days prior written notice has been given to the City Clerk, City of Anaheim, 200 S. Anaheim Blvd., Anaheim, CA 92805. This does not apply to cancellation for non-payment of premium, which requires notice of not less than ten (10) days.

Each insurance policy required by this Agreement, except policies for Professional Liability and Workers’ Compensation, shall contain the following clauses or shall otherwise provide for the following conditions:
“It is agreed that any insurance maintained by CONSULTANT pursuant to this Agreement shall be primary to, and not contribute with, any insurance or self- insurance maintained by the City of Anaheim.”
“The City of Anaheim, its officers, agents, employees, representatives and volunteers are included as additional insured with respect to the scope of work, operations, and/or activities of or performed on behalf of or at the direction of the Named Insured, performed under this Agreement with the City of Anaheim.”
Prior to commencing any work under this Agreement, CONSULTANT shall deliver to ANAHEIM insurance certificates confirming the existence of the insurance required under this Agreement, and including the applicable clauses referenced above. Also, within thirty (30) days of the execution date of this Agreement, CONSULTANT shall provide ANAHEIM (i) endorsements to the insurance policies that add to these policies the applicable clauses referenced above, or (ii) in lieu of said endorsements, documentation acceptable to ANAHEIM evidencing that the coverage, terms, and conditions set forth in the above-referenced clauses are otherwise included in said insurance policies. Insurance required hereunder shall be placed with 7 insurers (i) admitted to write insurance in California, (ii) possessing an A. M. Best’s rating of A VII or higher, or (iii) otherwise acceptable to ANAHEIM, with prior written permission from ANAHEIM. In the event that a claim or other legal action is filed against ANAHEIM, and if ANAHEIM, in its good faith opinion, believes it may have coverage under any of the insurance required herein, then ANAHEIM has the right to demand, and to receive within a reasonable time period, copies of the insurance policies related to such required insurance; provided, however, that this provision shall not apply if the parties agree that CONSULTANT shall fully defend, hold harmless, and indemnify ANAHEIM against any such claim or other legal action.

In addition to any other remedies ANAHEIM may have if CONSULTANT fails to provide or maintain any insurance policies or policy endorsements to the extent and within the time herein required, ANAHEIM may, at its sole option:

A. Order CONSULTANT to stop work under this Agreement and/or withhold any payments which become due to CONSULTANT hereunder until CONSULTANT demonstrates compliance with the requirements hereof;
B. Terminate this Agreement.

Exercise of any of the above remedies, however, is an alternative to other remedies ANAHEIM may have and is not the exclusive remedy for CONSULTANT's failure to maintain insurance or secure appropriate endorsements.

Nothing herein contained shall be construed as limiting in any way the extent to which CONSULTANT may be held responsible for payment of damages to persons or property resulting from CONSULTANT's (or CONSULTANT’s contractors’ or subcontractors’, if any) performance of the work covered under this Agreement.

In the event CONSULTANT hires other persons or firms to perform some of the work related to this Agreement, CONSULTANT shall ensure, and certify to ANAHEIM in writing, (i) that the acts or omissions of such persons or firms are covered under the abovereferenced liability insurance, or (ii) that such firms maintain insurance equal to or better than, and subject to the same limits, terms and conditions as, the insurance required of CONSULTANT under this Agreement (except for firms which are not performing professional services-such firms 8 shall not be required to carry the above-referenced professional liability insurance); and in either instance, CONSULTANT shall provide, or cause to be provided, evidence of such insurance coverage, reasonably acceptable to ANAHEIM.

ANAHEIM’s Risk Manager is hereby authorized to amend or reduce the requirements set forth herein if the Risk Manager determines that such CONSULTANT generated amendment or reduction request is in ANAHEIM’S best interest.

8. PROFESSIONAL PRACTICES
All services to be provided by and through CONSULTANT pursuant to this Agreement shall be provided by personnel experienced and/or licensed, if applicable, in their respective fields and in a manner consistent with the standards of care, diligence and skill ordinarily exercised by professional consultants in similar circumstances in accordance with sound professional practices. Services provided by and through CONSULTANT will be furnished in accordance with generally accepted professional practices and principles and, if applicable, under the supervision of professionals licensed in the State of California.

CONSULTANT assumes responsibility for any and all negligence, errors or omissions that CONSULTANT commits and any and all such negligence, errors or omissions committed by a subcontractor of CONSULTANT in performance of this Agreement. Provided, however, CONSULTANT assumes no responsibility for any and all negligence, errors or omissions that ANAHEIM, or its EMPLOYEES, AGENTS or SUB AGENTS commit.

9. ASSIGNMENT
Neither CONSULTANT nor ANAHEIM may assign or transfer this Agreement, or any part thereof, without the written consent of the other party. Provided, that consent shall not be required in the context of merger and acquisition activities of CONSULTANT.

10. GOVERNING LAW
This Agreement shall be governed by the laws of the State of California. If any portion of this Agreement is held invalid under any applicable statute or rule of law, then such portion only shall be deemed invalid.

11. COMPLIANCE WITH LAWS
9 In the performance of this Agreement, CONSULTANT shall abide by and conform to any and all applicable laws of the United States, the State of California and the City Charter and Ordinances of ANAHEIM. For purposes of clarity, CONSULTANT reserves the right to object to any assertion by ANAHEIM that a particular provision of law is applicable.

12. WAIVER
No waiver or failure to exercise any right, option or privilege under the terms of this Agreement on any occasion shall be construed to be a waiver of any other right, option or privilege on any other occasion.

13. TERMINATION OF AGREEMENT
ANAHEIM may terminate this Agreement with or without cause upon giving CONSULTANT at least thirty-one (31) days' prior written notice. If this Agreement is terminated without cause, CONSULTANT will be paid for costs incurred and actual services satisfactorily performed for ANAHEIM up to and including the effective date of termination.

CONSULTANT may terminate this Agreement upon not less than sixty (60) days' prior written notice to ANAHEIM; provided, however, that CONSULTANT may terminate an applicable Group Policy in accordance with the termination provisions expressly set forth in such Group Policy. Termination or discontinuance of an individual Group Policy or benefit plan shall not, by itself, terminate this Agreement or any other Group Policy, benefit plan, or administrative service provided under this Agreement. Provided, however, this Agreement shall automatically terminate upon termination of the last group insurance policy that CONSULTANT issued to

ANAHEIM
Unless otherwise specifically provided in the applicable group insurance policy, CONSULTANT will have no further obligation to administer benefits or provide administrative services following the effective date of termination. Notwithstanding the foregoing, CONSULTANT shall continue to administer and process claims for which it retains responsibility under the applicable insurance policy or plan document, including claims incurred while such policy was in force, until such responsibilities terminate in accordance with the terms of the applicable policy or plan document. CONSULTANT shall, upon ANAHEIM’s written request, 10 cooperate in the transition of administrative services and transfer all applicable self-funded STD claim files, administrative records, and related data in its possession, that are subject to transfer to ANAHEIM or its successor plan administrator. Such transfer will be made within sixty (60) days after the date this Agreement terminates. Nothing herein shall require CONSULTANT to transfer claim files or records for claims it remains contractually obligated to administer under the applicable insurance policy.

14. NO THIRD-PARTY RIGHTS
The parties intend not to create rights in, or to grant remedies to, any third party as a beneficiary of this Agreement or of any duty, covenant, obligation or undertaking established herein.

15. ENTIRE AGREEMENT; PARTIAL INVALIDITY
This Agreement, together with Exhibits A,B, and C, constitutes the entire agreement and understanding between the parties hereto, and supersedes all proposals, oral or written, and all other communications between the parties with respect to the subject matter of this Agreement.

This writing constitutes the entire agreement between the parties with respect to the subject matter hereof, and supersedes all oral or written representations or written agreements which may have been entered into between the parties. No modification or revision shall be of any force or effect, unless the same is in writing and executed by the parties hereto.

If any provision of this Agreement shall be held invalid, such invalidity shall not affect the other provisions hereof, and to this extent, the provisions of this Agreement are intended to be and shall be deemed severable. The parties shall agree, if reasonably practicable, upon provisions which are equivalent from an economic point of view to replace any provision which is determined to be invalid.

16. CONTRACT ADMINISTRATION
The Human Resources Director or their designee shall be responsible for the administration of this Agreement for ANAHEIM. Nothing contained in this section shall be construed to authorize the Human Resources Director to amend, cancel, waive, or otherwise 11 modify any terms of this Agreement, except to the extent such changes or modifications are expressly authorized by this Agreement. The City Manager, may, in writing, reassign the administration of this Agreement to another department head.

17. NOTICES
Notices and communication, except service of legal process which must be served in accordance with applicable law on CONSULTANT’S registered agent for service of process, concerning this Agreement shall be sent to the following addresses:

ANAHEIM: City of Anaheim
Attn: City Clerk
200 South Anaheim Boulevard
Anaheim, California 92805
Telephone: (714) 765-5166
Facsimile: (714) 765-4105
WITH A COPY TO: Human Resources Director
City of Anaheim
201 South Anaheim Boulevard
Anaheim, California 92805
Telephone: (714) 765-5111
Facsimile: (714) 765-5211
CONSULTANT: Standard Insurance Company
Attn.: Brent Snyder, Sr. Employee Benefits Consultant
1100 SW Sixth Avenue
Portland, OR 97204
Telephone: 949-202-7011
Email: [email protected]
Either party may, by notice to the other party, change the address specified above.

Service of notice or communication shall be complete, if personally served, when received at the designated address, or five (5) days after deposit of said notice or communication in the U.S. mail.

18. USE AND OWNERSHIP OF DOCUMENTS
Except with respect to CONSULTANT’S proprietary business records created in the ordinary course of its business, it is understood by and agreed between the parties that all documents prepared or developed by CONSULTANT pursuant to this Agreement in administering 12 the PLAN shall become the property of ANAHEIM and shall be either delivered to ANAHEIM or transferred to a successor administrator or claims evaluator upon completion of the services.

19. AUTHORITY
CONSULTANT and CONSULTANT’s signators represent that the signators hold the positions set forth below their signatures and that the signators are authorized to execute this Agreement on behalf of CONSULTANT and to bind CONSULTANT hereto

20. EFFECTIVE DATE
The effective date of this Agreement shall be January 1, 2027.

IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed on the dates hereinafter respectively set forth.

DATE OF EXECUTION: CITY OF ANAHEIM
a municipal corporation
By:
“ANAHEIM”
ATTEST:

By: _
Theresa Bass, City Clerk
DATE OF EXECUTION: STANDARD INSURANCE COMPANY, an
Oregon Corporation
By:

Title:

Printed Name:
“CONSULTANT”
13 APPROVED AS TO FORM:

ROBERT FABELA, CITY ATTORNEY
By:

Robert J. Tyson
Deputy City Attorney
Dated:

Attachments:

Exhibit A – Proposal
Exhibit B – Performance Guarantees
Exhibit C – Standard Master Agreement, Absence Management Service Agreement, STD Services Agreement, STD Program Document, LTD Insurance Policy, Life Insurance Policies and Certificates, AD&D Insurance Policy and Certificate, Member Notification Service Agreement, ADA Accommodation Services Service Agreement 14 EXHIBIT A
Proposal
Prepared for: City of Anaheim
Presented by: MERCER - IRVINE
Life and AD&D Insurance
Additional Life Insurance
Dependent Life Insurance
Accidental Death and Dismemberment
Insurance
Long Term Disability Insurance
Self-Funded Short Term Disability
Absence Management Services
Proposal Prepared on:

August 12, 2026
Proposed Effective Date:

January 1, 2027
Standard Insurance Company
Your Employee
Benefits Proposal
Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362239; 1
Life and AD&D Insurance
Handling a Life insurance claim takes a special touch. All of our Life benefits employees complete annual grief training helping them to empathize with beneficiaries and recognize when they need special attention. And we're focused on settling claims quickly: Our median calculation turnaround time in 2023 was 2 days for clean claims and 3 days for all claims (internal company data as of January 2024).

Covered Members
An active employee of the Employer working 40 or more hours per week.

Contributory Basic Life
Benefit Schedule Schedule varies by class
Maximum Benefit $750,000
Guarantee Issue $750,000
AD&D Benefit Matches Life Benefit
Age Reduction Schedule None
Employer Contribution 50%
Minimum Participation Greater of 100% or 10 Lives
Life Highlights
Voluntary
Waiver of Premium Eligible to age 60
Waived to age 65
Conversion Included
Portability Included
Continuity of Coverage Included
Repatriation Benefit Included
Travel Assistance Included
Life Services Toolkit Included
Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362239; 2
AD&D Highlights
Contributory Basic AD&D
Loss of life 100% (including disappearance and exposure) Loss of one hand or one foot 50%
Loss of sight of one eye 50%
Loss of speech 50%
Loss of hearing in both ears 50%
Any combination of the above
losses 100%
Loss of thumb and index
finger of same hand 25%
Quadriplegia 100%
Triplegia 75%
Paraplegia 75%
Hemiplegia 50%
Uniplegia 25%
Seat Belt Benefit 10% of AD&D benefit payable up to $25,000 Air Bag Benefit 5% of AD&D benefit payable up to $5,000 Helmet Benefit 10% of AD&D benefit payable up to $5,000 Family Benefits Package Included
Portability Included
Additional Plan Design Details
• We offer a Performance Guarantee: If you are not satisfied with your experience, we will refund up to 10% of that coverage line's previous quarter's plan expenses, excluding commissions and premium tax. • An Accelerated Death Benefit is included. Terminally ill members may withdraw up to 80% of their Life benefit to a maximum of $500,000 (when Basic Life and any Additional Life are combined). • If Life is sold with Standard's LTD, then the LTD claim will initiate a claim for Standard's Life Waiver of Premium. • The Family Benefits Package includes:
– The Higher Education Benefit reimburses tuition expenses up to $5,000 per child per year towards a 4-year college education for the deceased's children - not to exceed a cumulative total of $20,000 or 25% of the AD&D benefit per child, whichever is less. – Career Adjustment Benefit reimburses tuition expenses up to $5,000 per year to help a spouse to return to the workforce after the death of their spouse - not to exceed the cumulative total of $10,000 or 25% of the AD&D benefit, whichever is less. – Child Care Benefit reimburses a family's child care expenses up to $5,000 per year - not to exceed $10,000 or 25% of the AD&D benefit, whichever is less.
• The Helmet Benefit pays a benefit for a loss of life due to an accident that occurs when riding a bicycle or a motorcycle and wearing a helmet.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362239; 3
Additional Plan Design Details (continued)
• A hand and/or foot that is lost and later surgically reattached will still be considered a loss. • Travel Assistance is included and provides assistance with pre-trip planning, medical assistance services, emergency transportation services, travel and technical assistance services and legal referral. • The Life Services Toolkit is included and helps beneficiaries cope with grief and loss, get answers to legal questions, plan a memorial or a funeral, and address financial concerns. Additionally, all covered employees will have access to online will preparation and other estate planning documents as well as articles to help deal with identity theft, improve wellness and more. • The AD&D Occupational Assistance service is included and provides access to a Workplace Possibilities (SM) Consultant who helps those with a specified accidental dismemberment return to productive work and life. • Domestic partner language is included.
• Line of Duty benefit included for Public Safety Officers. • Expanded AD&D package one is included. Additional benefits apply for the Loss of one arm or one leg (75%), Loss of four fingers of the same hand (20%), Loss of all toes on the same foot (20%), Loss of thumb of the fifth finger pinky (15%), Assault benefit (50% of AD&D up to $25,000), Public Transportation Benefit (AD&D benefit payable up to $200,000), and Coma (5% of AD&D benefit payable per month for 11 months, remainder of AD&D benefit the 12th month).

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362239; 4
Cost
Contributory Basic Life
Life
Members 1,164
Volume $138,100,000
Rate: Per $1,000 .035
Monthly Premium $4,834
AD&D
Members 1,164
Volume $138,100,000
Rate: Per $1,000 .010
Monthly Premium $1,381
Total Billed Premium $6,215
Rate Guarantee 3 years
Assumptions
• Final rates are subject to change if actual enrollment varies from the assumed enrollment of 58% • Rates include electronic documents, printed contracts and certificates can be requested once annually at no cost. Additional printed materials are available for an additional cost.
• Rates assume billing is centralized in one location.
• Commissions are not included in a member's annual earnings. • The proposed rates assume coverage currentlRates assume Additional Life is included. • If the current contract contains a Waiver of Premium provision, The Standard assumes all waiver claims before the effective date of coverage with The Standard have been filed with the current carrier. • Series 20.
• Retiree coverage is available on a going-forward basis at a rate of $2.25 PER THOUSAND. No takeover of in force amounts. The schedule is $100 per year, $50 for a fraction of a year exceeding 6 months to a maximum $2,000. Retirees are eligible for Life coverage only. Retiree must have been enrolled in the Basic Life active coverage to be eligible for enrollment as a retiree.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362239; 5
Conditions
• We agree to match current class definitions and schedules. Combined Basic and Additional Life may not exceed $750,000. If your combined Basic and Additional Life insurance exceeds the combined maximum of $750,000, the voluntary Life benefit will be reduced, followed by a reduction in the Basic life amount if necessary. Final census would need to include class designations. • Except as provided in the Additional Plan Design Details, we require evidence of insurability for:
– Members who are eligible under the current plan but are not enrolled. – Individuals who enroll more than 31 days after they are first eligible for coverage. • The elected benefit amount for Basic AD&D must match the benefit amount for Basic Life. • Member must be insured under Basic Life in order to be eligible for Basic AD&D. • We agree to fund implementation support activities not to exceed $25,000 of expenses based on the sale of all lines. If all lines are not sold, the implementation amount will reduce accordingly, subject to the following conditions:
(1) All expenses to be reimbursed as an implementation credit must be reasonably related to the coverage(s) provided by The Standard.
(2) The invoice must contain sufficient detail describing the permissible expenses incurred and any billable hours and hourly rates charged directly related to the work completed. Where the invoice includes a request for reimbursement for time worked, it must include the hours worked for everyone, the hourly rate for each individual and a description of the activity completed. (3) The implementation credit shall not be used to offset any one-time charges assessed by The Standard in its proposal including, but not limited to, data feed or implementation fees.
(4) The implementation credit will not be paid in a manner allowing duplicate expense reimbursements. For example, The Standard will not pay an implementation credit for expenses it is reimbursing under a benefit administration or technology fee. (5) All invoices for reimbursement must be submitted at one time within 180 days of the policy effective date and expenses incurred within 90 days of the effective date.
(6) Fees paid will be disclosed to the policyholder via the 5500 form. The cost has been included in the proposed rates. (7) Implementation credits can only be paid subject to applicable law.

More Information
For additional information on the available features and benefits of Life and AD&D Insurance from The Standard, click here:
https://www.standard.com/group_life_add
Speak to your Sales Representative or Account Manager to learn about potential discounts on Anthem Medical premiums.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362239; 6
Additional Life Insurance
Covered Members
An active employee of the Employer working 40 or more hours per week.

Employee Additional Spouse
Benefit Schedule Increments of $50,000 Increments of $25,000 Maximum Benefit $750,000 $250,000
Minimum Benefit $50,000 $25,000
Guarantee Issue $250,000 $50,000
Age Reduction Schedule None None
Employer Contribution 0% 0%
Minimum Participation Greater of 20% or 10 Lives 20%
Life Highlights
Employee Additional Spouse
Waiver of Premium Eligible to age 60
Waived to age 65
Not Included
Conversion Included Included
Portability Included Included
Continuity of Coverage Included Included
Additional Plan Design Details
• On the policy effective date, all members (enrolled or eligible) may increase their benefit amount up to the guarantee issue amount without providing evidence of insurability.
• On the policy effective date, all members (enrolled or eligible) may increase their spouse's benefit amount up to the guarantee issue amount without providing evidence of insurability.
• An Accelerated Death Benefit is included. Terminally ill members may withdraw up to 80% of their Life benefit to a maximum of $500,000 (when Basic Life and any Additional Life are combined). • An Accelerated Benefit is not available for dependents. • Life insurance for dependents continues automatically, without premium payment, for five months after the death of the insured member.
• The benefit amounts under the current plan are carried forward to this plan.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362239; 7
Cost
Employee
Life
Members 560
Volume $100,650,000
Rate: Per $1,000 Lives Age Rate Volume Premium
2 21
37 62
84 102
115
72 41
20 3
1 0-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-999
.060
.060
.060
.080
.120
.200
.300
.480
.600

1.100

1.840
$100,000
$3,650,000
$7,150,000
$11,900,000
$17,800,000
$20,950,000
$19,200,000
$11,050,000
$5,750,000
$2,500,000
$350,000
$250,000
$6
$219
$429
$952
$2,136
$4,190
$5,760
$5,304
$3,450
$2,750
$644
$900
Monthly Premium $26,740
Rate Guarantee 3 years
Additional Spouse
Life
Members 263
Volume $20,200,000
Rate: Per $1,000 Lives Age Rate Volume Premium
0 4
11 22
44 50
66 31
21 11
2 1
0-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-999
.060
.060
.060
.080
.120
.200
.300
.480
.600

1.100

1.840

3.600
$0
$325,000
$825,000
$1,575,000
$4,000,000
$4,850,000
$4,425,000
$2,325,000
$1,100,000
$650,000
$75,000
$50,000
$0
$20
$50
$126
$480
$970
$1,328
$1,116
$660
$715
$138
$180
Monthly Premium $5,783
Rate Guarantee 3 years
Assumptions
• Final Additional Life rates are subject to change if actual enrollment varies from the assumed enrollment of 48%. • Final Additional Spouse Life rates are subject to change if actual enrollment varies from the assumed enrollment of 47%

3.600
Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362239; 8
Assumptions (continued)
• Rates include electronic documents, printed contracts and certificates can be requested once annually at no cost. Additional printed materials are available for an additional cost.
• Rates assume billing is centralized in one location.
• Commissions are not included in a member's annual earnings. • The proposed rates assume coverage currently in force. • If the current contract contains a Waiver of Premium provision, The Standard assumes all waiver claims before the effective date of coverage with The Standard have been filed with the current carrier.

Conditions
• Additional Life can only be purchased in conjunction with Basic Life. • Combined Basic and Additional Life may not exceed $750,000. If your combined Basic and Additional Life insurance exceeds the combined maximum of $750,000, the voluntary Life benefit will be reduced, followed by a reduction in the Basic life amount if necessary.
• Member's Basic Life benefits plus Additional Life benefits may not exceed 8 times annual earnings. • Until coverage has been in force for two years (one year in Colorado, Minnesota, Missouri and North Dakota), death that results from suicide or other intentionally self-inflicted injury is not covered. This exclusion does not apply to plans written in Washington. • Except as provided in the Additional Plan Design Details, we require evidence of insurability for:
– Increases in elected benefit amounts from the current plan to this plan. – Members who are eligible under the current plan but are not enrolled. – Spouses who are eligible under the current plan but are not enrolled. – Individuals who enroll more than 31 days after they are first eligible for coverage. – Increases in elected benefit amounts after initial enrollment. • Member must be enrolled in Additional Life to enroll in the Spouse Life plan. • Spouse Life can't exceed 50% of member's enrolled benefit for Additional Life.

More Information
For additional information on the available features and benefits of Additional Life Insurance from The Standard, click here:
https://www.standard.com/group_life_add
Speak to your Sales Representative or Account Manager to learn about potential discounts on Anthem Medical premiums.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362239; 9
Dependent Life Insurance
Covered Members
An active employee of the Employer working 40 or more hours per week.

Spouse and Child
Benefit Schedule Spouse: $10,000
Child: $10,000
Guarantee Issue Full Benefit
Life Highlights
Spouse and Child
Conversion Included
Portability Included
Continuity of Coverage Included
Additional Plan Design Details
• No evidence of insurability is required for child coverage. • Life insurance for dependents continues automatically, without premium payment, for five months after the death of the insured member.
• Dependents coverage includes child(ren) from live birth through age 25. The first eligible newborn child is automatically covered at the minimum benefit amount for up to 31 days. After the first child is enrolled, subsequent children will be automatically covered at the elected child benefit amount.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362239; 10
Cost
Spouse and Child
Elective: Paid by each Member electing coverage
Life
Members 622
Rate: Per Member $0.769
Rate Guarantee 3 years
Conditions
• Except as provided in the Additional Plan Design Details, we require evidence of insurability for:
– Increases in elected benefit amounts from the current plan to this plan. – Spouses who are eligible under the current plan but are not enrolled. – Children who are eligible under the current plan but are not enrolled.

More Information
For additional information on the available features and benefits of Dependent Life Insurance from The Standard, click here:
https://www.standard.com/group_life_add
Speak to your Sales Representative or Account Manager to learn about potential discounts on Anthem Medical premiums.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 2- 4362810; 11
Accidental Death and Dismemberment Insurance
Support after an accidental death or severe injury can provide much-needed financial assistance through a difficult time. Our AD&D insurance includes a Family Benefits Package designed to help surviving family members maintain their standard of living and pursue their dreams.

Covered Members
An active employee of the Employer working 30 or more hours per week.

Voluntary AD&D Insurance
Employee
Benefit Schedule Flat $50,000
Age Reduction Schedule None
Employer Contribution 0%
Loss of life (including
disappearance and exposure) 100%
Loss of both hands, or both
feet, or sight of both eyes 100%
Loss of one hand and one foot 100%
Loss of sight of one eye and
either one hand or one foot 100%
Loss of sight of one eye and
loss of speech 100%
Loss of sight of one eye and
loss of hearing in both ears 100%
Loss of either one hand or one
foot and loss of speech 100%
Loss of either one hand or one
foot and hearing in both ears 100%
Loss of speech and hearing in
both ears 100%
Loss of one hand or one foot,
even if surgically reattached 50%
Loss of sight of one eye 50%
Loss of speech 50%
Loss of hearing in both ears 50%
Loss of thumb and index
finger of same hand 25%
Quadriplegia 100%
Hemiplegia 50%
Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 2- 4362810; 12
Voluntary AD&D Insurance
Employee
Paraplegia 50%
Seat Belt Benefit AD&D benefit payable up to $10,000
Air Bag Benefit AD&D benefit payable up to $5,000
Family Benefits Package Included
Repatriation Benefit Included
Additional Plan Design Details
• This plan provides 24-hour coverage for accidents and dismemberments occurring on or off the job. • Commissions are not included in a member's annual earnings. • The Family Benefits Package includes:
– The Higher Education Benefit reimburses tuition expenses up to $5,000 per child per year towards a 4-year college education for the deceased's children - not to exceed a cumulative total of $20,000 or 25% of the AD&D benefit per child, whichever is less. – Career Adjustment Benefit reimburses tuition expenses up to $5,000 per year to help a spouse to return to the workforce after the death of their spouse - not to exceed the cumulative total or $10,000 or 25% of the AD&D benefit, whichever is less. – Child Care Benefit reimburses a family's child care expenses up to $5,000 per year - not to exceed $10,000 or 25% of the AD&D benefit, whichever is less.
• AD&D insurance for dependents continues automatically, without premium payment, for five months after the death of the insured member.
• Dependents coverage includes child(ren) from live birth through age 25. • The AD&D Occupational Assistance service is included and provides access to a Workplace Possibilities (SM) Consultant who helps those with a specified accidental dismemberment return to productive work and life. • Domestic partner language is included.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 2- 4362810; 13
Cost
Voluntary AD&D Insurance
Employee
Members 106
Volume $5,300,000
Rate: Per $1,000 .025
Monthly Premium $133
Rate Guarantee 3 years
Assumptions
• Final rates are subject to change if actual enrollment varies from the assumed enrollment of 5% • Rates include electronic documents, printed contracts and certificates can be requested once annually at no cost. Additional printed materials are available for an additional cost.
• Rates assume billing is centralized in one location.
• The proposed rates assume coverage currently in force.

Conditions
• The minimum number of lives for this plan is 10 enrollees.

More Information
For additional information on the available features and benefits of Accidental Death and Dismemberment Insurance from The Standard, click here: http://www.standard.com/group-add
Speak to your Sales Representative or Account Manager to learn about potential discounts on Anthem Medical premiums.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362240; Plan 2- 4365299; 14
Long Term Disability Insurance
Protect your employees' income and your company's bottom line. This insurance comes with innovative resources designed to help you build a more productive workplace. Our Workplace Possibilities(SM) program, included at no extra cost, helps employees stay on the job and return to work sooner. While not all claims can be shortened, our customers are currently experiencing anywhere from a 10% to a 25% reduction in disability days who participate in the Workplace Possibilities Program. That's just one example of how we add real value as your partner.

Covered Members
Plan 1 Plan 2
A regular Employee other than Police Association and Fire Safety Employees working 40 or more hours per week.

A regular Police Association employee working 40 or more hours per week.

Group LTD Plan 1 Group LTD Plan 2
Benefit Schedule 60% 60%
Insured Predisability
Earnings $21,667 $21,667
Maximum Monthly Benefit $13,000 $13,000
Minimum Monthly Benefit $100 $100
Benefit Waiting Period 180 Days 180 Days
Maximum Benefit Period To SSNRA To SSNRA
Guarantee Issue Benefit
Amount Full Benefit Full Benefit
Employer Contribution 100% 100%
Minimum Participation 100% 100%
Taxability of Benefits Taxable Taxable
Own Occupation Period 24 Months 24 Months
Partial/Residual Disability Included Included
Preexisting Condition Period 3/12 3/12
Mental & Nervous Limitation 24 months 24 months
Drug & Alcohol Limitation 24 months 24 months
Musculoskeletal/Connective
Tissue Limitation 24 months 24 months
Chronic Fatigue Limitation 24 months 24 months
Environmental Sensitivities
Limitation 24 months 24 months
Return to Work Incentive 12 months 12 months
Employee Assistance Program Included: 3 face-to-face Included: 3 face-to-face Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362240; Plan 2- 4365299; 15
Additional Plan Design Details
• We offer a Performance Guarantee: If you are not satisfied with your experience, we will refund up to 10% of that coverage line's previous quarter's plan expenses, excluding commissions and premium tax. • The own occupation definition of disability requires an earnings loss OR an inability to perform the substantial and material acts of the own occupation.
• The Standard pays the employer's matching FICA and Medicare taxes and prepares W-2s for members receiving LTD benefits. • The plan includes the Workplace Possibilities(SM) program, an innovative approach to addressing and reducing the causes of absence and disability - with innovative tools and resources designed to help keep your employees productive and on the job. • This coverage includes a $25,000 Reasonable Accommodation Expense Benefit, which reimburses employers for workplace modifications that enable employees to return to or remain at work. The Reasonable Accommodation Expense Benefit is separate from the LTD claim payment.
• A Rehabilitation Plan Benefit is included, which increases the LTD benefit amount by 10% of predisability earnings, not to exceed the maximum benefit, when member is participating in an approved rehabilitation plan. This benefit will also assist in paying for approved expenses incurred by a disabled member a part of an approved rehabilitation plan. • 12-month Family Care Expenses Adjustment.
• Survivors Benefit pays a lump sum equal to 3 times the non-integrated LTD benefit. • Continuity of Coverage.
• Each limitation in the policy is a separate lifetime limitation, not combined. • Domestic partner language is included.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362240; Plan 2- 4365299; 16
Cost
Group LTD Plan 1 Group LTD Plan 2
Members 1,393 408
Volume $13,191,470 $5,051,137
Rate: Percent of earnings .251 .290
Monthly Premium $33,111 $14,648
Rate Guarantee 3 years 3 years
Assumptions
• Sick leave paid to the member will be used as deductible income. • Workers' compensation benefits will be considered deductible income. • Benefits received from individual disability plans will not be used as deductible income. • Primary and dependents Social Security benefits will be used as deductible income. • Rates include electronic documents, printed contracts and certificates can be requested once annually at no cost. Additional printed materials are available for an additional cost.
• Rates assume billing is centralized in one location.

Rates assume members participate in Public Employee Retirement System, and State Disability Income.

Conditions
• Rate assumes that coverage is currently in force.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 4362240; Plan 2- 4365299; 17
Conditions (continued)
• We agree to fund implementation support activities not to exceed $25,000 of expenses, based on the sale of all lines. If all lines are not sold, the implementation amount will reduce accordingly, subject to the following conditions:
(1) All expenses to be reimbursed as an implementation credit must be reasonably related to the coverage(s) provided by The Standard.
(2) The invoice must contain sufficient detail describing the permissible expenses incurred and any billable hours and hourly rates charged directly related to the work completed. Where the invoice includes a request for reimbursement for time worked, it must include the hours worked for everyone, the hourly rate for each individual and a description of the activity completed. (3) The implementation credit shall not be used to offset any one-time charges assessed by The Standard in its proposal including, but not limited to, data feed or implementation fees.
(4) The implementation credit will not be paid in a manner allowing duplicate expense reimbursements. For example, The Standard will not pay an implementation credit for expenses it is reimbursing under a benefit administration or technology fee. (5) All invoices for reimbursement must be submitted at one time within 180 days of the policy effective date and expenses incurred within 90 days of the effective date.
(6) Fees paid will be disclosed to the policyholder via the 5500 form. The cost has been included in the proposed rates. (7) Implementation credits can only be paid subject to applicable law.

More Information
For additional information on the available features and benefits of Long Term Disability Insurance from The Standard:

Click here for California: http://www.standard.com/ca-group-long-term-disability Click here for all other states: http://www.standard.com/group-long-term-disability Speak to your Sales Representative or Account Manager to learn about potential discounts on Anthem Medical premiums.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 19569; 18
Self-Funded Short Term Disability
Covered Members
An active employee of the Employer working 40 or more hours per week.

Administrative Services Only
Benefit Schedule varies by class
Service Details
• We offer a Performance Guarantee: If you are not satisfied with your experience, we will refund up to 10% of that coverage line's previous quarter's plan expenses, excluding commissions and premium tax. • No pre-funding required.
• The Standard will furnish full claim management with seamless transition to LTD, when appropriate. • The Standard will handle communication with the claimant, employer and physician. • The Standard will pay for all fees associated with undergoing independent medical exams or obtaining medical records deemed necessary by The Standard.
• Administrators may easily access and monitor claims experience and payment history through Reports Online. • The Standard will submit employer's portion of FICA tax and issue W-2s to claimants. Plan sponsor will reimburse The Standard for all FICA & Medicare taxes submitted.
• The Standard will provide claim decision support and ongoing management for specified claims. • Benefits will be paid to claimants on a weekly basis.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 19569; 19
Cost
Administrative Services Only
Members 2,013
Rate: Per Member $1.72
Monthly Fees $3,462
Rate Guarantee 3 years
Optional Features & Services
• Fees include minor wording modifications to The Standard's plan documents, claim submission forms and/or form letters. Any modifications to plan documents, claim submission forms, letters or other documents are subject to approval by The Standard.

Assumptions
• Fees do not include commissions.
• Fees include electronic documents. Printed documents are available for an additional cost. • Fees assume non-occupational coverage.

Conditions
• May only be purchased with The Standard's Long Term Disability product.

More Information
For additional information on the available features and benefits of Self-Funded Short Term Disability from The Standard, click here:http://www.standard.com/self-funded-disability
Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 19245; 20
Absence Management Services
Our Absence Management Services solution utilizes an in-house platform on which to integrate the intake, management and reporting of Family and Medical Leave (FML) and other types of leave. When applicable, Short Term Disability (STD) and very short elimination period Long Term Disability (LTD) claims can also be integrated with the concurrent leave.

Absence Management Services
Leave Options
Family and Medical Leave
(FML) Federal, State and USERRA Leaves
Company-Sponsored Leave With or without payment, including but not limited to: personal or medical leave, bereavement, jury duty, voting, and sabbaticals Absence Management Service Center
Single Point of Intake for
Leaves and Claims
Your employees can report all leaves, including STD and LTD when applicable, in a single point of intake using our web portal, available 24/7, or by calling our Absence Management Service Center from 8 am to 8 pm EST Communication with
Employer
We email you when an employee submits a leave request and will communicate with you throughout the employee leave process
Communication with
Employee
We send letters or emails to employees to inform them of eligibility, communicate leave determination or request additional information
Superior Customer Service
We provide industry-recognized expertise and take pride in earning and keeping customer business by offering dedicated, caring and attentive service to all our customers
Call Recording All incoming and outgoing calls related to Absence Management can be recorded and provided to employers upon request, subject to regulatory limitations
Satisfaction Surveys Employer and employee satisfaction surveys can be performed on a regular basis to measure overall customer experience Reporting
One of the most important aspects of integrated absence management is the insight that can be provided to you about your employee leaves
Employee Level Reports To help you identify irregular leave patterns, greater than average leave usage, highest physician approval, etc Summary Reports Absence Summary, Incidence Summary, Physician Summary and Detail Reports Detailed Implementation Process
To ensure that your specific needs are met, a detailed implementation plan will be shared with you. In addition to our regular services, certain customizations may be accommodated at an additional cost.

Customized Phone Numbers We can offer dedicated phone numbers for your employees as well as help you keep existing toll free phone numbers in order to minimize disruption upon change of leave management provider Customized Intake Scripts In addition to the questions asked to fulfill the employees leave request, information can be gathered at the time of intake to accommodate specific circumstances or reporting needs
Customized Correspondence Changes can be made to the letters and emails sent to you and your employees to reflect company-specific information Customized Reporting We can modify our typical reports to meet your specific reporting needs, within regulatory guidelines Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 19245; 21
Service Details
• We offer a Performance Guarantee: If you are not satisfied with your experience, we will refund up to 10% of that coverage line's previous quarter's plan expenses, excluding commissions and premium tax. • Pricing is based on specific data and format requirements. If these requirements are not fully met, additional fees may be assessed and service interruptions could occur. The data and format requirements include a complete electronic eligibility data feed as well as a historical file in a standard format for the transfer of existing leaves (if applicable). Documents outlining the detailed requirements are available upon request.
• The Standard will act as the company-sponsored leave claim administrator and is authorized to receive, process, and investigate claims, as well as make initial decisions to approve, deny, or close claims. • Company-sponsored leave claims will be administered by The Standard for the additional fee noted in the Optional Features & Services. Any claim payments due will be paid by The Standard on a weekly basis. • The Standard will prepare tax documents according to state requirements for employees that receive company-sponsored leave claim payments.
• The Employer is solely responsible for the cost of company-sponsored leave claim payments under the terms of the Absence Service Agreement and will reimburse The Standard for any claim payments including FICA and Medicare taxes submitted where applicable. • One-time fees for takeover leaves and additional data feeds apply at both time of new sale and at time of acquisition(s), if applicable. • The takeover of open claims refers to FML or other open leaves only. It does not include STD, which is handled separately. • 120-day implementation timeline.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 19245; 22
Cost
Absence Management Services
Number of Covered
Employees 3,385
Assumed Incidence Rate 20%
Per Employee Per
Month (PEPM) $2.55
-Federal FML Included In PEPM
-State Leaves Included In PEPM
-One Recurring
Data Feed Included In PEPM
Rate Guarantee 3 years
One-Time Implementation Fee $0
Optional Features & Services
Absence Management Services
Company-Sponsored Leave with Tracking Only $.08 PEPM
Company-Sponsored Leave with Calculation or
Payment Not Applicable
Pregnancy Accommodation Service $.45 PEPM
Additional Data Feeds Sent to The Standard $1,500 Per Data Feed Takeover of Open Claims (FML, accommodations,
or Company-Sponsored Leaves with tracking or
calculations only, not applicable to
Company-Sponsored Leaves with payment)
$150 Per Claim not to exceed a total cost of $7,500
ADAAA Accommodation Services $.85 PEPM
• One company-sponsored leave without payment made by The Standard is included in the total fee at no additional charge.

Administration of any additional company-sponsored leaves (tracking) will be at the PEPM fee indicated. • The Standard's ADAAA resources integrate with The Standard's Absence Management Service Center by identifying those employees who are nearing exhaustion of their FMLA benefits or who may need assistance to return to work. Additionally, employers may refer employees who need an accommodation to stay at work. The Standard's ADAAA services are not an ADAAA compliance service, and an employer cannot solely rely on it to ensure their ADAAA compliance. However, these services give an employer additional tools to enhance and assist with an employer's own ADAAA efforts. The Standard's ADAAA service requires an additional service agreement that must be submitted prior to taking effect.

Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 19245; 23
Optional Features & Services (continued)
• For employers that utilize Absence Management Services we offer an add-on service that supports an employer's Pregnancy Accommodation program called Pregnancy Accommodation Service. All employees of the company, not just those covered by our disability plan can receive services. All of the employer's employees, not just those covered a disability plan with The Standard (STD or LTD), are eligible to receive the service. Employers will identify and then refer employees that may need support under the Pregnancy Workers Fairness Act (PWFA) or Providing Urgent Maternal Protections for Nursing Mothers Act (PUMP). Pregnancy Accommodation Service requires an additional service agreement that must be submitted prior to taking effect. • The Standard's Pregnancy Accommodation Service is not a compliance service and an employer cannot solely rely on it to ensure their PWFA or PUMP compliance. However, these services give an employer additional tools to enhance and assist with an employer's own PWFA or PUMP compliance efforts.

More Information
For additional information on the available features and benefits of Absence Management Services from The Standard, click here:
http://www.standard.com/absence-management
For additional information on the available features and benefits of our ADAAA Accommodation Services from The Standard, click here: https://www.standard.com/eforms/20593.pdf
Proposed Effective Date
January 1, 2027
Prepared for:

City of Anaheim
Plan 1- 19245;
Producer Compensation Disclosure
We recognize the valuable role of insurance advisors, consultants and brokers ("producers") in helping their clients design an employee benefits program, and we support reasonable and fair compensation for these services. Producers may be eligible to receive compensation from The Standard.

The commission quoted in this proposal are noted below. Additionally, fees for administrative, marketing or consulting services may apply.

If applicable, fees are noted below.

No commissions included for Service.

Flat 4% commission included for Life.

Flat 1% commission included for LTD.

Unless participation is declined by the producer or client, contingent compensation is additional compensation that may also be paid and is dependent on the satisfaction of one or more minimum requirements, such as a specified amount of new premium volume or persistency in connection with the producer's block of business. For information about our customary producer rewards program visit www.standard.com/financial-professional/insurance-benefits/compensation. Some producers may have a contingent compensation arrangement that differs from our customary program. Please consult with your producer for additional details.

About This Employee Benefits Proposal
We appreciate the opportunity to provide you with this benefit and cost summary proposal from The Standard. This document outlines certain important features of the group insurance coverages available. This is not a contract or an offer to contract for such coverages.

Detailed information about other important features of the coverage proposed is available on request. Just ask your broker/consultant or your representative at The Standard.

A completed application must be submitted before a group can be considered for coverage. Insurance will be effective after the application is accepted by The Standard. If approved, we will issue a contract containing our customary language. It will not duplicate policy language from another carrier. The group contract will contain provisions and defined terms not described in this Employee Benefits Proposal. The group contract will control if there are discrepancies between it and this proposal.

This benefit and cost summary proposal expires on September 30, 2026, unless replaced or withdrawn by The Standard.

The proposed premium rate and plan design for each coverage are based on the underwriting data received by The Standard. Final premium rates and plan provisions will be determined by The Standard on the basis of: applicable state laws, policyholder contributions, confirmation of occupations, the actual composition of the group of persons who will become insured and our current underwriting rules and practices.

Financial Strength Ratings
For information about our Financial strengths ratings visit: https://www.standard.com/about-standard/company/financial-strength The Standard is a marketing name for StanCorp Financial Group, Inc. and subsidiaries. Insurance products are offered by Standard Insurance Company of 1100 SW Sixth Avenue, Portland, Oregon in all states except New York. Product features and availability vary by state and are solely the responsibility of Standard Insurance Company. 15 EXHIBIT B
Performance Guarantees
Measure Target Reporting Methodology Formula Reporting Frequency Assessment Frequency
Annual % of
Total Funds at
Risk
Comments
STD Claims
95% of STD claims will
receive a determination
to approve, pend, or
deny within 5 business
days of claim
assignment
Via timeliness report
Number of claims determined
within 5 business days
÷
Total number of claims
determined during the reporting
period
Semi-Annual Annually 16.66%
Measured from the date all information is
available to process the claim to the date
claim decision is made. Measurement is
based upon business days.

STD Claims 97.00%
Via audit sampling of STD
claim decisions. Audit 100%
of STD claims up to a
maximum of 30 for any
quarter.

Total number of procedures
handled correctly
÷
Total number of procedural
requirement
Semi-Annual Annually 16.66%
Procedural accuracy is how accurately the
claim was handled. Key claim procedures
measured are member’s address, Social
Security Number, date of birth, division
name/administrative unit, diagnosis code,
future close date and communication to
Employees and Employer within 2 business
days of approval or 5 business days of
approval for closed period or denial.

STD Claims 97.00%
Via audit sampling of STD
claim decisions. Audit 100%
of STD claims up to a
maximum of 30 for any
quarter.
1- Total dollar amount of
payment errors
÷
Total dollars payable
Semi-Annual Annually 16.66%
Payment accuracy is how accurately the
computation of the benefits is for a given
claim, including all deductions, taxes, offsets,
and adjustments.

Member Satisfaction with Initial
Claim Decision
Average score of
“Satisfied” (3 or higher)
on member surveys
Monthly Transaction Report
Sum of responses to Overall
Satisfaction question
÷
Total number of respondents
Semi-Annual Annually 16.66%
100% of all initial STD claim decisions will
be surveyed. Survey instrument rating is on a
1 to 5 scale.

Mails FMLA Notification packet
timely
98% acknowledgement
of initial notice of claim
and/or FML Notification
packet will be sent out in
2 business days
Via timeliness report
Number of leaves
acknowledged within 2 business
days
÷
Total number of claims
acknowledged
during the reporting period
Semi-Annual Annually 50%
Makes FMLA determinations in a
timely manner
95% within 5 business
day of receipt of
complete information.

Via timeliness report
Number of leaves
determined within 5 business
days
÷
Total number of claims
determined
during the reporting period
Semi-Annual Annually 50%
PERFORMANCE GUARANTEES - City of Anaheim
Initial Decision Turnaround Time
Procedural Accuracy
Financial Accuracy
Account Management
Disability Member/Claimant Satisfaction
Absence
Measure Target Reporting Methodology Formula Reporting Frequency Assessment Frequency
Annual % of
Total Funds at
Risk
Comments
PERFORMANCE GUARANTEES - City of Anaheim
Account Satisfaction Survey Average score of
“Satisfied” (3 or higher)
on account surveys.

Sum of responses to
Overall Satisfaction question
Total number of respondents
Semi-Annual Annually 16.66%
Reports – Financial and Claims
• STD Experience report
• Performance Guarantee report
• Claim Detail report
• STD Utilization reports
IMPORTANT NOTES:

FORMULA: All performance guarantee metrics are measured and reported on City of Anaheim's own results, not The Standard's book of business.

The Standard shall not be considered to have failed to perform its obligations under the agreement if any delay or nonperformance on its part is due, in whole or in part, to City of Anaheim's failure to discharge its own obligations timely.

No penalty will be paid to City of Anaheim if they are delinquent on premium/fee payments to The Standard.

Effective Date:

City of Anaheim:

Signature of authorized representative Date
Print name and title of authorized representative
Standard Insurance Company:

Signature of authorized representative Date
Print name and title of authorized representative
ASSESSMENT PERIOD: All performance guarantee metrics are guaranteed on an annual basis. At the end of the annual assessment period, The Standard will not payout any penalties if City of Anaheim's overall satisfaction is met. <=60 days after
end of reporting
period
Via electronic distribution Not applicable Semi-Annual Annually 16.70% If due date falls on a vendor holiday or a weekend, reports are due next business day.

The Performance Guarantee will remain in force for the current policy period. At the end of the policy period The Standard and policyholder will review and determine if the Performance Guarantee shall remain in force and if so, what the terms shall be for the new policy period.

The Standard shall be exempted from the liability for failure to perform the obligations partially or fully under this agreement in cases of force majeure which includes natural disasters, accidents, fires, civil disorders, war, prohibitions of the government, enactments of legislative and executive authorities which impede the fulfillment of the obligations by The Standard under this agreement and other circumstances beyond the control of The Standard. If The Standard cannot perform this agreement due to force majeure, it shall immediately notify the policyholder, and try its best to minimize the possible losses as sustained by the policyholder. The Standard maintains the right to determine, in it's sole discretion, if a performance measurement standard has been achieved in compliance with this agreement.

TOTAL FUNDS AT RISK: For each Policy Period, the maximum penalty payable in aggregate by The Standard to City of Anaheim as a consequence of failing to meet any or all of the foregoing Performance Guarantees is an amount not to exceed 10% of STD annual ASO fees and 10% of Absence Management fees at risk. STD metrics are tied to STD fees & Absence Management metrics are tied to Absence Management fees.

Penalties will not apply to any line of coverage with fewer than 20 paid claims (or equivalent volume, such as surveys received) during the annual assessment period. In addition, no penalty will be assessed for any metric missed due to two or fewer errors attributable to The Standard.
16 Exhibit C
Standard Master Agreement
Absence Management Service Agreement
STD Services Agreement
STD Program Document
LTD Insurance Policy
Life Insurance Policies and Certificates
AD&D Insurance Policy and Certificate
Member Notification Service Agreement
ADA Accommodation Services Service Agreement
Standard Insurance Company Agreement No. 764999
Master Agreement Page 1 of 4 Issued 9/2026

STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282

MASTER AGREEMENT
Client: City of Anaheim
Master Agreement Number: 764999
Master Agreement Effective Date: January 1, 2027
This Master Agreement (the "Agreement") is between Client and Standard Insurance Company, an Oregon corporation ("Standard").

Client and Standard agree as follows:

1. Services.

A. Standard shall provide services in accordance with written service agreements, each of which shall reference this Agreement and constitute a separate transaction independent of other service agreements. Standard shall provide the services during the term provided for in the service agreements.

Service agreements are subject to the terms of this Agreement. Each service agreement will contain additional terms and conditions specific to the services described in that service agreement. No service agreement will be effective unless it has been signed by Client and accepted by Standard. In the event of a conflict between any terms of this Agreement and those contained in a service agreement, the conflicting terms in the service agreement will prevail; however, the specific or additional terms set forth in any service agreement shall apply to the parties’ rights and obligations under that service agreement only, and not to any other service agreement.

B. Any change in services will be set forth in a written amendment to the applicable service agreement.

No amendment will be effective unless it has been signed by Client and accepted by Standard.

2. Use of Name. Except to the extent necessary to perform services and to fulfill obligations under a service agreement, neither party shall use the name, trademark, logo or identification of the other party without the other party’s prior written consent.

3. Right to Inspect Records. Subject to applicable law, each party agrees to allow the other, on reasonable written notice and at reasonable time and places, to inspect and photocopy, at the inspecting party’s sole expense, any material files and records in such party’s possession relating to the service performed under a service agreement.

4. Assignment and Subcontracting. This Agreement shall not be assigned by Client without Standard’s written consent. Standard shall not enter into a subcontract solely and exclusively for the performance of any services under this Agreement or service agreement without the advance written agreement of the Client. Client shall not withhold any such consent unreasonably.

5. Relationship of the Parties. Standard and Client are each acting under this Agreement and any service agreement as an independent contractor and not as an employee, joint venturer or partner of the other. Neither party nor their respective employees shall have any authority to make any representation, contract or commitment on behalf of the other party unless specifically requested or authorized to do so by authorized personnel of such other party.

Standard Insurance Company Agreement No. 764999
Master Agreement Page 2 of 4 Issued 9/2026

6. Employee Benefit Plan Services and Fiduciary Status of Standard. It is understood that with respect to any services Standard may provide under this Agreement or any written service agreements incorporated herein that relates to an employee benefit plan, the legal and tax status of such plan under applicable law are matters for the Client’s determination, and that Standard bears no such responsibility. Final authority and responsibility for any such plans and their operation are vested in the Client, and Standard is empowered to act on behalf of the Client for such plans only as expressly stated in this Agreement or as mutually agreed in writing by Standard and the Client. Client represents and warrants that no such plans currently or at any time will designate Standard the administrator, a fiduciary nor a named fiduciary of such plans, except as expressly agreed to by Standard or as required by applicable law.

7. Indemnification.

As respects acts, errors or omissions in the performance of professional services, Standard agrees to indemnify and hold harmless Client, its officials, officers, and employees from and against any and all claims, losses, damages, defense costs, or liability, of any kind or nature directly arising out of the negligent acts, errors or omissions of the Standard or any sub-agent in the performance of his professional services under this Agreement. As respects all acts or omissions which do not arise directly out of the performance of professional services, including but not limited to those acts, errors or omissions typically covered by general and automobile liability insurance, Standard agrees to indemnify and defend (at Client 's option), and hold harmless Client, its officials, officers, employees, agents and representatives from and against any and all claims, losses, demands, defense costs, liability, of any kind or nature (collectively referred to hereinafter as “Claims”), arising out of or in connection with Standard 's (or Standard 's agent or sub-agent, if any) acts, errors, omissions, or work, relative to this Agreement; except for those Claims that arise out of the sole negligence or willful misconduct of Client.

The obligations set forth in this indemnification provision (i) shall be in effect without regard to whether or not Client, Standard, or any other person maintains or fails to maintain, insurance coverage, or a self-insurance program, for any such Claims; and (ii) shall survive the termination of this Agreement.

8. Termination. Termination of this Agreement shall be governed by the termination provisions of the City of Anaheim Agreement to which this Agreement is attached; provided, however, that Standard may terminate an applicable Group Policy in accordance with the termination provisions expressly set forth in such Group Policy.

In the event of any conflict or inconsistency regarding termination of this Agreement, the termination provisions of the City of Anaheim Agreement shall control.

9. Confidential Information.

A. "Confidential Information" means Client’s information that is not generally released to third parties in the absence of confidentiality requirements; or is not generally released to third parties unless required by law; or is classified under state or federal law as confidential or private information which disclosure is restricted by law; or is proprietary to Client or the disclosure of which would be detrimental to Client.

B. Standard shall maintain the confidential and proprietary nature of Confidential Information and shall: (i) restrict disclosure of such Confidential Information to its own employees to whom the Standard determines disclosure is reasonably necessary as having a "need to know"; (ii) advise such persons of the obligations of confidentiality hereunder with respect to such Confidential Information; (iii) make disclosures to third party contractors and other non-employees under Standard’s control who have a "need to know" only if such third party contractors and other non-employees execute a non-disclosure agreement that require they treat Confidential Information with the same degree of care, and to limit disclosure of Confidential Information, as set forth in the terms and conditions of this Agreement; (iv) limit the number of copies made of such Confidential Information to those reasonably necessary to fulfill the purpose of this Agreement or service agreement (and reproduce any legends or notices of the confidentiality or proprietary nature on each copy), except that no copies shall be made of computer software programs or related documentation except pursuant to the terms of any separate license or other agreement governing Standard’s rights in that software or documentation; (v) use such Confidential Information for the purposes of this Agreement or service agreement and in accordance with applicable laws and regulations; (vi) share Confidential Information, including with third parties, only for the benefit of the Client for the purposes of this Agreement or service agreement, or any other applicable agreements between Standard and the Client, provided that such sharing is in compliance with cybersecurity and privacy statutory frameworks such as but not limited to: the California Consumer Privacy Act, the California Privacy Rights Act, the Health Information Portability and Accountability Act, Standard Insurance Company Agreement No. 764999
Master Agreement Page 3 of 4 Issued 9/2026
and the Gramm-Leach-Bliley Act and; (vii) use substantially the same degree of care to maintain the confidentiality of such Confidential Information as Standard uses with respect to its own Confidential Information (but in any event not less than a reasonable standard of care). These obligations do not apply to information or materials that are or become generally known by third parties other than as a result of an act or omission by Standard; were already independently known by Standard prior to receiving them from Client; or are developed independently by Standard.

C. At Client’s direction, Standard shall share Client Confidential Information with third parties to streamline and coordinate the administration of benefits and management of employees. Client shall obtain all necessary rights, consents, and authority to direct such sharing, and Standard shall have no liability for complying with Client’s directions.

D. Standard may disclose Confidential Information if required by law.

10. Warranties. Standard warrants that:

A. It is licensed to conduct its business as it is now being conducted and is authorized to do business in each state in which it provides services;
B. The services will be performed on time and will be performed in a professional manner in accordance with service providers practicing under similar conditions and in accordance with generally acceptable industry standards;
C. The services will be performed in accordance with all applicable laws, regulations or other legal requirements in effect as of the date services are performed; and D. Its personnel are trained, qualified and have direct experience in performing the services. Standard warrants the performance of any subcontractor used in performance of the services in the same manner that Standard warrants its own personnel.

11. Force Majeure. Neither party shall be responsible for any delay or failure in performance of any part of this Agreement or service agreement to the extent that such delay or failure is caused by fire, flood, explosion, war, embargo, government requirement, civil or military authority, act of God, act or omission of carriers or other similar causes beyond its control.

12. Governing Law. This Agreement and all service agreements shall be subject to and construed under the laws of the State of California.

13. This agreement is part of a package of agreements between the City and Standard governing the relationship between the parties. Except as may be specifically noted, to the extent there is a conflict between this Agreement or a service agreement and the City's standard agreement, the City's standard agreement will prevail over any and all agreements specifically with respect to services under this agreement and any service agreement.

14. Amendment and Waiver. Except as expressly provided in this Agreement, neither this Agreement, service agreement, nor any term thereof may be amended, waived, discharged or terminated other than by a written instrument signed by both parties. The failure of either party to insist on strict compliance with this Agreement or any service agreement, or to exercise any right or remedy under this Agreement or any service agreement, shall not constitute a waiver of any rights or remedies provided under this Agreement or any service agreement, nor stop the parties from demanding full and complete compliance nor prevent the parties from exercising such a right or remedy in the future.

15. Severability. If any provision of this Agreement or any service agreement becomes invalid or unenforceable by reason of any change in the law or by reason of the decision of any court or government agency, the remaining provisions shall remain in effect unless either party determines in good faith that the elimination of the provision found to be invalid or unenforceable subjects that party to prosecution, civil penalty, loss of license or material economic burden in which event that party may notify the other party in writing and seek renegotiation of that portion of the Agreement or service agreement found to be invalid or unenforceable.

16. Duplicate Originals. This Agreement may be executed in one or more duplicate counterparts, each of which shall be deemed to be an original, but which collectively shall constitute one and the same instrument.

Standard Insurance Company Agreement No. 764999
Master Agreement Page 4 of 4 Issued 9/2026
The parties are signing this Agreement on the dates indicated below.

STANDARD INSURANCE COMPANY CITY OF ANAHEIM
By:

Name:
(Please Print)
Title:

Date:

By:

Dan McMillan
President and CEO
Date: September 8, 2026
MAST26 (9/2026)
Standard Insurance Company Service Agreement No. 764999 Absence Management Service Agreement Page 1 of 7 Issued 9/2026

STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282

ABSENCE MANAGEMENT

SERVICE AGREEMENT
Client: City of Anaheim
Master Agreement Number: 764999
Absence Management Service Agreement Number: 764999
Absence Management Service Agreement Effective Date: January 1, 2027 This Absence Management Service Agreement ("Service Agreement") is made part of the above referenced Master Agreement between Standard Insurance Company ("Standard") and Client.

1. Scope of Absence Management Services.

A. Standard's absence management services consist of the following:
(1) Administration of federal Family and Medical Leave Act (FMLA); (2) Tracking leaves taken for military service under the Uniformed Services Employment and Reemployment Rights Act (USERRA);
(3) Administration of unpaid state family and medical leave laws; (4) Administration of other unpaid state leave laws;
(5) Administration of leave(s) under Client’s Company Sponsored Leave of Absence (CSL) Policies, if applicable, and for which Client has and provides plan documents to support administration includes City Administrative Regulations, Personnel Rules, and agreements with applicable employee unions, according to procedure agreed upon between the Client and Standard, excluding administration of any benefit calculation(s) or payment(s).

Standard is entitled to rely upon such plan documents as an accurate and complete description of the Client’s leave of absence policies.
(6) A combined administrative process for management of leaves of absence covered by this Service Agreement together with any fully insured disability policies issued by Standard.

B. Standard will perform the absence management services in accordance with its internal operational procedures.

C. Standard will provide correspondence templates that support the leaves administered. Any changes or customizations requested by Client will not be reviewed by Standard for compliance with any laws or any special agreements such as a collective bargaining agreement.

D. Standard can track all leaves under administration in accordance with Client’s systems in increments of one minute or greater. Unless specified otherwise, all leaves under administration tracked by Standard will be in one-minute increments.

E. Provide periodic compliance updates notifying Client of changes in the law that may be of interest or impact leave administration processes; provided, however, that such updates may not cover all law changes Standard Insurance Company Service Agreement No. 764999 Absence Management Service Agreement Page 2 of 7 Issued 9/2026 applicable to Client and Client remains solely responsible for tracking and complying with all applicable legal developments.

2. Employees Covered under this Service Agreement.

Standard will provide absence management services to all employees regardless of whether the employees are covered under other Standard plans sponsored by Client.

3. Affiliates Covered by this Service Agreement.

A. For the purposes of this Service Agreement, "Client" includes any applicable affiliate(s) and/or subsidiary(ies) as agreed upon by the parties.

B. Client warrants that it has the authority to enter into this Service Agreement on behalf of any affiliates and/or subsidiary(ies).

C. Administration for other entities identified under this section that require additional processes (such as administration of distinct company-sponsored leave of absence policies) may result in additional charges or costs that will need to be mutually agreed upon by Standard and Client prior to commencement of administration.

4. Client’s Obligations. Client shall:

A. Provide Standard with employee and Client data required by Standard to set up, implement, and administer absence management and related services covered in this Service Agreement; and provide such data in a media (electronic or paper) and a format requested by Standard.

B. Provide data feeds of the data described in Client’s Obligations above on a bi-weekly basis as determined by the Client and Standard to maintain service levels as described in the Eligibility Feed Specifications document, and Historic Data Conversion Specifications, and any other information necessary to implement the absence management service for Client.

C. Provide Standard, in writing, the names of individuals authorized to act for Client in connection with this Service Agreement, together with a statement of the extent of their authority, and promptly notify Standard when such authorization ends. Standard may rely on the actions and/or directions provided by such authorized individuals to the extent of their communicated authority and shall not be liable for any acts or omissions based on such reliance.

D. Furnish any information reasonably required by Standard to carry out its duties under this Service Agreement, including but not limited to accurate information regarding an employee's weekly work schedule.

E. Provide Standard, in writing, copies of all Client's CSL Policies, if applicable, that Standard is administering on behalf of Client, including amendments or revisions, as may reasonably be required for Standard to fulfill its obligations under this Service Agreement. Standard is entitled to rely on such leave policies in the performance of its obligations under this Service Agreement. Standard shall not be liable for any failure of Client's leave policies to comply with applicable law, or for any delay by Client in communicating amendments or revisions to such policies, provided that Standard shall remain responsible for performing its obligations under this Service Agreement.

F. Provide Standard with all amendments or modifications to Client's CSL Policies, if applicable, effectuating change in the leave administration at least 60 days prior to the proposed effective date of any change.

Standard shall have no obligation to administer any such change unless and until approved by Standard, which approval shall not be unreasonably withheld. Standard retains the right to modify the Fees to reflect any additional services or expenses necessary or appropriate, as determined in Standard’s sole discretion, to carry out such change.

G. Execute authorizations or corollary agreements necessary for Standard to execute its obligations under this Service Agreement.

H. Retain authority to make final determinations on whether or not an individual employee is eligible for any of the leaves administered by Standard under this Service Agreement.

Standard Insurance Company Service Agreement No. 764999 Absence Management Service Agreement Page 3 of 7 Issued 9/2026 I. Retain the duty to comply with other notice requirements not otherwise specified in this Service Agreement. (e.g. posting requirements, language translation requirements).

J. Pay the costs of any and all independent medical exams ("IMEs"), scheduled at the request of the Client for obtaining second or third opinions that are permitted by state or federal laws. Billing procedures for IMEs are to be mutually agreed upon by the parties.

K. Provide a response within 2 business days to Standard's inquiries regarding employee eligibility or information otherwise not provided on the eligibility feed.

L. Identify Standard as Leave Administrator in relevant Client CSL Policies, if applicable, and related materials as appropriate to facilitate administration. Any other use of Standard’s name in connection must be authorized in advance and in writing by Standard.

M. Defend claim litigation, investigation, action, or inquiry arising out of or relating to, in whole or in part, the responsibility of Client for the risks, liabilities, and benefits of Client’s CSL Policies, if applicable, regardless of whether such liability, claim, lawsuit, or administrative proceeding is rightfully or wrongfully brought or filed. Client agrees that Standard may, at Standard’s option and expense, assume the defense obligation of any such liability, claim, lawsuit, or administrative proceeding. In the event Standard exercises this option to assume the defense, Standard shall have the sole authority for the direction of defense, including selecting defense attorneys and determining defense strategy. In such event, Standard shall be empowered to judge the acceptability of any compromise and to settle any such liability, claim, lawsuit or administrative proceeding. Prior to entering into any settlement or compromise on behalf of Client, Standard will make a recommendation to Client for approval, which approval shall not be unreasonably withheld.

N. For purposes of this Service Agreement, the Client has the sole and exclusive discretion, authority, and responsibility for the design, drafting, interpretation, operation, and legal compliance of its leave of absence policies. Where applicable, Client has the responsibility for filing for, and/or obtaining, regulatory approvals from appropriate regulatory authorities for such policies and for any other requirements imposed on Client by law in relation to such policies unless otherwise specifically agreed to be administered by the Company under this Service Agreement.

O. Authorize Standard to collect directly from employees submitting requests for CSL(s) information sufficient for Standard to administer the leave(s) under the Policies, if applicable.

P. Bargaining Employees:

In the event the services to be provided under this Service Agreement will involve payments to persons covered under a collective bargaining agreement, such services are conditioned on the Client providing Standard a copy of the collective bargaining agreement. Client shall provide to Standard any updates to such collective bargaining agreements no later than 15 days prior to the effective date of the application of such updates.

5. Standard’s Obligations. Standard shall:

A. As defined in Scope of Absence Management Services, investigate leaves submitted by employees and/or by the Client on their employees’ behalf, track eligibility for leave (based on Client data feeds), make initial decisions to approve, deny or close leaves, determine the amount of benefits payable (if applicable), and notify claimant and Client in writing of its decisions, subject to Client’s right of final review and decision on all leaves.

B. Record Keeping and Reporting
(1) Maintain accurate records of all leaves processed in accordance with applicable law and Standard’s record retention policies and procedures.
(2) Provide the Client with regular reports detailing the leaves processed and benefit payable (if applicable).

C. If an appeal is requested by the claimant, provide an independent review and notify claimant and Client in writing of Standard’s decision, subject to Client’s right of final review and decision on all appeals. The appeal must be submitted directly to the Client (employee’s employer) in accordance with the Client’s leave of absence policies instructions.

Standard Insurance Company Service Agreement No. 764999 Absence Management Service Agreement Page 4 of 7 Issued 9/2026 D. Advise and assist Client on procedures to be followed in submission of leaves including the preparation of any forms necessary for submission and processing of requests.

E. Create and maintain a current and complete leave file for any leaves presented to Standard for administration under the Scope of Absence Management Services.

F. Review leaves to determine continued eligibility as frequently as claimant's need for leave warrants.

G. Submit to Client all leaves an authorized individual (named pursuant to Client’s Obligation) may request to review.

H. Standard may refuse to act in accordance with any request of Client if Standard determines, in its sole discretion, that compliance with such request may result in the violation of any law, regulation, or agency interpretation.

6. Fees and Payment.

A. The fees for the services described in this Service Agreement are shown in the Fee Schedule below.

B. Standard may change the amount, the method of determination, or both, of any fees not yet due, when:
(1) A change in any law or regulation affects the manner in which Standard performs any function under this Service Agreement; or
(2) The incidence rate is 20% or more higher in the first year than what was assumed for pricing; or factors material to the underwriting risk we assumed, including but not limited to the number of lives under administration, change by 25% or more; or
(3) If the scope of the Client’s CSL Policies has changed entailing increased administrative functions to be performed by Standard; or
(4) Client and Standard mutually agree in writing to a change in fees.

Upon becoming aware of items (1), (2), or (3) above, a party shall notify the other party within 30 days.

In the event any of the foregoing items occur, Standard may cease services under this Service Agreement unless the parties mutually agree either to changes in administrative practices and procedures, implementation timeframes, and/or fee adjustments.

C. Except as provided above, the fees will not be changed during the Initial Rate Guarantee Period of January 1, 2027 to January 1, 2030. Thereafter, Standard may change the amount, the method of determination, or both, of any fees not yet due, upon 31 days written notice to Client. No such change in fees shall be made more than once in any calendar year.

D. All fees are due and payable within 60 days of receipt of invoice.

Standard Insurance Company Service Agreement No. 764999 Absence Management Service Agreement Page 5 of 7 Issued 9/2026 Fee Schedule
Service Description Fee
Administrative Services "Per Employee Per
Month" (PEPM) For FMLA, State Leaves,
USERRA, and one CSL with leave tracking
$2.25
PEPM cost per additional CSL with leave tracking $0.08
Takeover of Open Leaves1
Flat rate
or
Per leave
$7,500
$150
One Time Implementation Fee
Additional Data Mapping Fee (per additional
feed)1
$1,500
1Flat rate of $7,500 for takeover of more than 50 active leaves, unless the total number of leaves is or drops below 50, in which case the rate is calculated at $150 per leave. Rate also includes the loading of historical data as part of the takeover process, provided the employer has credible historical data.

One-time fees for takeover leaves and additional data feeds apply at both time of new sale and at time of acquisition(s), if applicable.

7. Additional Services. In the event that Client desires that Standard perform consulting or other services related to leave management that are not otherwise outlined in this Service Agreement, and if Standard agrees to provide such additional services, then Standard and Client will agree on the rate to be charged by Standard for performance of additional services prior to the commencement of any additional work.

8. Performance Standards. Standard shall exercise ordinary care and reasonable diligence in the performance of its duties under this Service Agreement. Standard will not be liable for any mistake of judgment or other action taken in good faith. Further, Standard shall not be considered to have failed to perform its obligations under this Service Agreement if any delay or nonperformance on its part is due, in whole or in part, to Client’s failure to discharge its own obligations promptly. Standard shall not be required to perform services under this Service Agreement that (i) by their nature cannot be performed by Standard, such as restoring an employee’s employment following approved leave to the extent required by law, and (ii) are not included in Standard’s services. The Client shall retain responsibility to resolve all disputes with its employees or employees’ representative and/or beneficiaries concerning the Client’s leave of absence policies and procedures.

9. Record Ownership and Leave Files.

A. All documents, records, reports and data stored in Standard's possession or maintained by a third party on Standard’s behalf, relating to the administration of Client's leave and other services under this Service Agreement shall at all times be considered the property of Client, subject to the following:
(1) Standard's right to possession during the continuance of this Service Agreement, and for as long as necessary to satisfy Standard recordkeeping obligations and policies. (2) Records obtained for the purpose of investigating and administering disability claims under Standard's insurance policies are owned by Standard and shall be retained pursuant to applicable insurance laws and Standard's records retention policy.

B. Upon request, Standard will provide copies to Client of such documents, records, reports, and data in a mutually agreeable format and may charge a reasonable fee.

C. All leave files and other records and reports prepared and maintained by Standard pursuant to this Service Agreement shall be confidential. Standard shall take such measures as are reasonably necessary to preserve the confidentiality of such leave files, records and reports. No individually identifiable information will be released from any such leave file, except as follows:
(1) In response to a court order.

Standard Insurance Company Service Agreement No. 764999 Absence Management Service Agreement Page 6 of 7 Issued 9/2026 (2) For an examination conducted by regulatory authorities. (3) At the request of the Client.
(4) With the written consent of the identified individual or his or her legal representative.

D. Client shall designate employees or agents who are authorized to receive individually identifiable leave information on behalf of the Client. Standard may rely upon such authorizations until receipt of written instructions changing such authorizations.

E. Any individually identifiable leave information released to the Client pursuant to this Service Agreement shall be treated as confidential. Client shall protect such information from unauthorized disclosure.

F. Leave files, records, reports and other information prepared and maintained by Standard pursuant to this Service Agreement may be destroyed by Standard at any time after seven years. With respect to leave files, the seven-year period begins on the date benefits cease to be paid to the claimant. Client may receive an inactive leave file at any time within the first 60 days after benefits cease by sending a written request to Standard and payment of Standard's reasonable shipping and handling costs.

10. Change to Service Agreement. The terms of the absence management services are governed under the Master Agreement and this Service Agreement. The Service Agreement may be changed in whole or in part.

No change in the Service Agreement will be valid unless it is approved in writing and signed by both Standard and the Client. Client and Standard represent and warrant that signers to any changes are authorized to accept changes to the Service Agreement.

11. Disclaimers.

A. While Standard will track and report leaves as specified in this Service Agreement and will also take responsibility for leave administration as specifically agreed to in this Service Agreement, Standard cannot guarantee Client's compliance with other laws, (such as the Americans with Disabilities Act Amendments Act of 2008 (ADAAA), workers' compensation laws, and the Consolidated Omnibus Budget and Reconciliation Act (COBRA)) that may impact employee leave rights or rights upon termination of employment.

Note: Some states have anti-discrimination laws which may require employers to provide accommodations which could include a leave of absence. Unless otherwise specified in this Service Agreement or specifically agreed upon by Standard and Client, these leave accommodations are not part of Standard's absence management services.

B. Historical leaves taken over by Standard from prior vendor or employer: Standard’s absence management system will default to an 8 hour/day, 40 hour/week, Monday through Friday work week when historical absences are loaded. Client acknowledges that for those employees with an alternative work schedule, leave usage and entitlement balances may not be accurately reflected.

C. Some Clients may be subject to certain laws, or have company policies that provide accrued leave or salary during an approved leave of absence. Standard does not administer paid leave policies, except as expressly stated in the Service Agreement.

D. Unless otherwise provided for in a separate agreement, Standard does not manage or administer state Paid Family and Medical Leave, Paid Family Leave or similar leave laws. Standard does not manage or administer local paid or unpaid leave laws.

E. Certain leave laws may specify that an employer is required to maintain specific health or other benefits during an employee's leave of absence. Standard does not assist with collection of premium or other fees associated with such obligations.

F. Standard shall not be considered to have failed to perform its obligations under this Service Agreement if any delay or nonperformance on its part is due, in whole or in part, to Client's failure to discharge its own obligations promptly.

G. Standard is not responsible for timely notification or administration of leaves (consistent with the timeframes outlined in this Service Agreement) in situations where Standard did not receive timely notification of the need for leave.

Standard Insurance Company Service Agreement No. 764999 Absence Management Service Agreement Page 7 of 7 Issued 9/2026 H. Standard shall not be held responsible for complying with timeliness guarantees where Client has instructed Standard to designate leave based on determination by a secondary source.

I. Some reports and notifications provided as part of this absence management service contain private, sensitive or medical information. Client remains responsible for determining who within Client's organization have access or permissions to review reports or receive emails. Client represents and warrants that it maintains reasonable safeguards to prevent the unauthorized access or acquisition of such information as required by applicable law.

J. Standard's absence management service is limited to the service described in this Service Agreement, and any service not described is considered outside the scope of Standard’s service and remains the responsibility of Client.

K. Standard will rely on the information furnished to it by the Client or any third party on behalf of the Client.

Standard shall have no liability for providing the services described or referenced in this Service Agreement based on such information. The Client has a continuing duty to update the information provided to Standard under this Service Agreement.

12. Termination of Service Agreement. This Service Agreement terminates automatically when the Client no longer has short term disability coverage with Standard.

If Standard, in its discretion, agrees to perform any run out services pertaining to the absence management services provided during the term of this Service Agreement, Standard and Client shall agree in writing to the scope of such services and the fees to be paid to Standard. In that event, Standard would transmit invoice(s) to the Client for any such services rendered following termination, such invoices to be paid to Standard upon receipt. For purpose of this provision, run‐out services refer to those services provided immediately following termination of this Service Agreement that relate to leaves or requests for benefits under the applicable plan that are received by Standard prior to the termination date.

The parties are signing this Service Agreement on the dates indicated below.

STANDARD INSURANCE COMPANY CITY OF ANAHEIM
By:

Name:
(Please Print)
Title:

Date:

By:

Dan McMillan
President and CEO
Date: September 8, 2026

STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282
(503) 321-7000

DISABILITY PROGRAM ADMINISTRATIVE SERVICES AGREEMENT
Program Sponsor: City Of Anaheim
Program Administrator: City Of Anaheim
Claims Administrator: Standard Insurance Company
ASO Number: 764500
Effective Date: January 1, 2027
Program Sponsor has adopted a self-funded short-term disability income benefit program (Program) for certain of its employees. Program Sponsor is solely responsible for all risks, liabilities, benefits and claims under the Program.

Program Sponsor has requested Standard to provide administrative services to the Program as described in this Agreement. Standard is willing to provide such services, according to the terms of this Agreement, without assuming any financial responsibility under the Program.

Standard's willingness to provide administrative services is conditioned upon Program Sponsor's agreement that Standard is not responsible for any risk, liability, benefit or claim under the Program and upon Program Sponsor fulfilling its obligations as provided herein.

Administrative Services Agreement 764500

LIMITED AGENCY APPOINTMENT OF STANDARD
Program Sponsor hereby appoints Standard to act on its behalf as Claims Administrator for the Program and grants to Standard authority to fulfill the Obligations of Claims Administrator, as provided herein. Standard is empowered to act on behalf of Program Sponsor in connection with the Program only as expressly stated in this Agreement. Standard has no authority or obligation with respect to (1) Program Sponsor's right of subrogation under the Program, or (2) management or investment of the assets of the Program. In performing its obligations under this Agreement, Standard is acting solely as the agent of Program Sponsor.

OBLIGATIONS OF CLAIMS ADMINISTRATOR
Standard, acting as Claims Administrator for the Program, shall provide the following services, consistent with the terms of the Program :

A. Claims Services
1) Investigate claims for benefits under the Program, determine eligibility for coverage, make initial claim decisions to approve, deny or close claims for benefits, determine the amount of benefits payable, and notify claimants and Program Sponsor in writing of its decisions, subject to Program Sponsor’s right of final review and decision on all claims.
2) If an appeal is requested by the claimant, provide an independent review and notify claimant and Program Sponsor in writing of Standard’s decision, subject to Program Sponsor's right of final review and decision on all appeals.
3) Advise and assist Program Sponsor on procedures to be followed in submission of claims, including the preparation of forms necessary for submission and processing of claims. 4) Create and maintain a current and complete claim file for any claim presented to Standard for administration under the Program.
5) Submit to Program Sponsor all claims Program Sponsor may request to review. 6) Issue checks in a timely manner in payment of claims approved. 7) Prepare benefit statements for claimants setting forth the benefit schedule applicable and explaining any adjustments.
8) Have medical and vocational examinations of claimants performed as Standard deems advisable 9) If required under the terms of the Program, advise claimants concerning the need to apply for deductible income and periodically verify application for or receipt of deductible income. 10) Collect any overpayment of benefits paid to claimants, by applying Program benefits payable to reduce the amount of overpayment due under the Program. This Agreement does not give Standard authority to pursue subrogation remedies on behalf of Program Sponsor.
11) Review claims to determine continued eligibility for benefits as frequently as claimant's condition warrants. 12) Upon written request, provide Program Sponsor with periodic listings of all payments made under the Program B. Tax Withholding and Related Services
1) Withhold federal income and employment taxes from benefit payments and deposit such amounts with the Internal Revenue Service under Standard's employer identification number (EIN). Prepare and distribute Form W-2 reports for such taxes and benefits.

Under Internal Revenue Code section 105(a) benefits paid under the Program are included in employee gross income and subject to tax to the extent such amounts are attributable to contributions by the employer that were not includable in the gross income of the employee.

Administrative Services Agreement 764500
To the extent Program benefits are included in employee gross income, such benefits are "wages" as provided in IRC sections 3121(a) and 3401(a). Standard shall withhold federal income tax using the applicable flat rate as provided in IRS regulation 31.3402(g)-1. However, if the employee provides a valid Form W-4, Standard shall withhold federal income tax using the percentage method under IRC section 3402(b). Standard shall withhold federal employment taxes as provided in IRS regulation 31.3102-1 and temporary regulation 32.1. 2) On behalf of Program Sponsor, pay the employer's matching Social Security and Medicare taxes and deposit such amounts under Standard's EIN. Standard shall not be responsible for payment of any other federal or state employment or other taxes, including unemployment taxes (FUTA).

C. Program Document Services
1) Advise and assist Program Sponsor with regard to the initial preparation of the Program and recommend subsequent revisions as may be appropriate.
2) Advise and assist Program Sponsor with regard to the preparation and review of Program summaries, descriptive booklets, certificates of coverage and similar material for distribution to covered employees.

D. Actuarial Services
Upon written request, submit to Program Sponsor periodic reports summarizing the financial experience of the Program and provide data required for compliance with state and federal disclosure legislation.

E. Performance Standards
Standard shall exercise ordinary care and reasonable diligence in the performance of its duties under this Agreement. Standard will not be liable for any mistake of judgment or other action taken in good faith. Further, Standard shall not be considered to have failed to perform its obligations under this Agreement if any delay or nonperformance on its part is due, in whole or in part, to Program Sponsor's failure to discharge its own obligations promptly.

OBLIGATIONS OF PROGRAM SPONSOR
Program Sponsor shall:

A. Retain full financial responsibility for the Program and its operation.

B. Furnish any information reasonably required by Standard to carry out Standard’s duties under this Agreement, including but not limited to:
1) Relevant program documents and any other administrative guidance necessary to administer the program. 2) For each claim listed in Exhibit A, the amount of the benefit payable, the date benefit payments are to end, and the amount of any federal income tax, Social Security and Medicare taxes to be withheld.

C. Execute authorizations or corollary agreements necessary for Standard to execute its obligations under this Agreement.

D. Review Standard's claim and appeal decisions in a timely manner. If Program Sponsor fails to notify Standard in writing of any objection it may have to any such decision within 45 days after notice thereof from Standard, Program Sponsor shall be deemed to have waived such objection and shall be conclusively presumed to have ratified and approved Standard's decision.

E. Defend claim litigation arising out of or relating to, in whole or in part, the financial responsibility of Program Sponsor for the risks, liabilities and benefits of the Program, regardless of whether such liability, claim, lawsuit, or administrative proceeding is rightfully or wrongfully brought or filed. Program Sponsor agrees that Standard may, at Standard’s option and expense, assume the defense obligation of any such liability, claim, lawsuit, or administrative proceeding. In the event Standard exercises this option to assume the defense, Standard shall have the sole authority for the direction of defense, including selecting defense attorneys and determining defense strategy. In such event, Standard shall be empowered to judge the acceptability of any compromise and to settle any such liability, claim, lawsuit or administrative proceeding. Prior to entering into any settlement or compromise Administrative Services Agreement 764500
on behalf of Program Sponsor, Standard will make a recommendation to Program Sponsor for approval, which approval shall not be unreasonably withheld.

F. Promptly reimburse Standard from the Program Sponsor’s general assets for benefits advanced and taxes paid by Standard under the Program.

G. Establish and maintain such accounts and records as may be required in accordance with this Agreement.

H. Provide Standard with all amendments or modifications to the Program at least 60 days prior to the proposed effective date of the change. Standard shall have no obligation to administer any such change unless and until approved by Standard, which approval shall not be unreasonably withheld. Standard retains the right to modify the Fees to reflect any additional services or expenses required by such change.

I. Provide Standard in writing with the names of individuals authorized to act for Program Sponsor in connection with this Agreement, together with a statement of the extent of their authority.

J. Identify Standard as Claims Administrator in relevant Program documents and related materials. Any other use of Standard’s name in connection with Program administration must be authorized in advance and in writing by Standard.

BENEFIT PAYMENTS AND REIMBURSEMENTS
A. Benefits payable under the Program will be paid by checks drawn against Standard’s accounts. The Program Sponsor will reimburse Standard for all benefits paid, administrative fees, and Social Security and Medicare taxes paid by Standard on behalf of Program Sponsor, within 15 days after Standard sends notice to the Program Sponsor of the amount due Standard. Standard will notify the Program Sponsor of the amount due as often as Standard deems necessary, but no less than once each month.

B. If Program Sponsor fails to reimburse Standard for all such benefits paid as well as any outstanding administrative fees and/or taxes owed by the Program Sponsor, within 30 days after notice of the amount due is sent by Standard, Standard shall cease issuing benefit checks until Standard has been reimbursed in full.

C. If at any time during the term of this Agreement, Program Sponsor fails for a second time to reimburse Standard as required, Standard shall cease issuing benefit checks and may, at its option, immediately terminate this Agreement and institute collection action.

FEES
A. Fees
Program Sponsor shall pay fees to Standard in connection with Standard's services under this Agreement as follows.

MONTHLY GENERAL FEE. The Monthly General Fee for the first calendar month of this Agreement and for each calendar month thereafter shall be $1.72 per employee covered under the Program.

ADDITIONAL FEES. Additional Fees may be charged to Program Sponsor upon mutual agreement between Program Sponsor and Standard.

B. Change in Fee Rates
1) Standard may change the amount, the method of determination, or both, of any fees not yet due, when a change in any law or regulation affects the manner in which Standard performs any function under this Agreement.

The amount, the method of determination, or both, of any fees not yet due may also be changed upon mutual agreement between Program Sponsor and Standard.
2) Except as provided in Paragraph 1) of this section:
a. Fees will not be changed during the first three years the Agreement is in effect, provided that this limitation shall not apply to any changes in fees in connection with any change in the terms of this Agreement or the Program.

Administrative Services Agreement 764500
b. Thereafter Standard may change the amount, the method of determination, or both, of any fees not yet due, upon 180 days written notice to Program Sponsor. Except as provided in Paragraph 1) of this section, no such change in fees shall be made more than once in any Contract Year, provided that this limitation shall not apply to any changes in fees in connection with any change in the terms of this Agreement or the Program.

C. Payment Due Dates
The Initial Monthly Fee is due and payable 30 days to the Effective Date. All other fees are due and payable 15 days after notice by Standard has been sent to Program Sponsor of the amount owed.

INDEMNIFICATION AGREEMENT
A. As respects acts, errors or omissions in the performance of professional services, Standard agrees to indemnify and hold harmless Program Sponsor, its officials, officers, and employees from and against any and all claims, losses, damages, defense costs, or liability, of any kind or nature directly arising out of the negligent acts, errors or omissions of the Standard or any sub-agent in the performance of his professional services under this Agreement.

As respects all acts or omissions which do not arise directly out of the performance of professional services, including but not limited to those acts, errors or omissions typically covered by general and automobile liability insurance, Standard agrees to indemnify and defend (at Program Sponsor 's option), and hold harmless Program Sponsor, its officials, officers, employees, agents and representatives from and against any and all claims, losses, demands, defense costs, liability, of any kind or nature (collectively referred to hereinafter as “Claims”), arising out of or in connection with Standard 's (or Standard 's agent or sub-agent, if any) acts, errors, omissions, or work, relative to this Agreement; except for those Claims that arise out of the sole negligence or willful misconduct of Program Sponsor. The obligations set forth in this indemnification provision (i) shall be in effect without regard to whether or not Program Sponsor, Standard, or any other person maintains or fails to maintain, insurance coverage, or a self-insurance program, for any such Claims; and (ii) shall survive the termination of this Agreement.

B. Nothing in this Indemnification Agreement section is intended to or does alter the obligations of the Program Sponsor to bear full financial responsibility for any benefits payable under the Program or to defend litigation related to such benefits as set forth in the Obligations Of Program Sponsor section of this Agreement.

RECORDS AND CLAIM FILES
A. All claim files, records, reports, and other information prepared and maintained by Standard pursuant to this Agreement shall be the sole property of Program Sponsor, subject to Standard's right to retain copies of any such information.

B. Upon reasonable written request, and during regular business hours Program Sponsor shall have the right to inspect any claim file and any other record or report, including but not limited to records relating to payments of benefits that have been prepared and maintained by Standard, pursuant to this Agreement.

C. All claim files and other records and reports prepared and maintained by Standard pursuant to this Agreement shall be confidential. Standard shall take such measures as are reasonably necessary to preserve the confidentiality of such claim files, records and reports. No individually identifiable information will be released from any such claim file, except as follows:
1) In response to a court order.
2) For an examination conducted by regulatory authorities. 3) At the request of the Program Sponsor.
4) With the written consent of the identified individual or his or her legal representative.

Pursuant to the Obligations Of Program Sponsor section of this Agreement, Program Sponsor shall designate employees or agents who are authorized to receive individually identifiable claim information on behalf of Program Administrative Services Agreement 764500
Sponsor. Standard may rely upon such authorizations until receipt of written instructions changing such authorizations.

D. Any individually identifiable claim information released to Program Sponsor pursuant to this Agreement shall be treated as confidential. Program Sponsor shall protect such information from unauthorized disclosure.

E. Claim files, records, reports and other information prepared and maintained by Standard pursuant to this Agreement may be destroyed by Standard at any time after seven years. With respect to claim files, the seven-year period begins on the date benefits cease to be paid to the claimant. Program Sponsor may receive an inactive claim file at any time within the first 60 days after benefits cease by sending a written request to Standard and payment of Standard's reasonable shipping and handling costs.

AMENDMENT
No modification or amendment of this Agreement shall be valid unless made in writing and signed by each party.

ASSIGNMENT AND MISCELLANEOUS PROVISIONS
A. Neither party shall assign this contract without the prior written consent of the other party.

B. Standard will not be bound by any notice, direction, requisition, or request unless and until it is received in writing at Standard's home office at Portland, Oregon.

C. This Agreement shall be deemed to have been entered into in the State of California, and all questions concerning validity, interpretation, or performance of any of its terms or provisions or of any rights or obligations of the parties to this Agreement, shall be governed by and resolved in accordance with the laws of California.

D. Captions of the parts, sections, and paragraphs of this Agreement are for convenience and reference only, and the words contained in such captions shall in no way be employed to explain, modify, amplify, or aid in the interpretation, construction, or meaning of the provisions of this Agreement.

E. Standard has not and will not provide legal advice, legal opinions or other legal services to Program Sponsor in establishing or maintaining the Program or relative to this Agreement. Program Sponsor will rely solely upon the advice of its own legal counsel in evaluating the legal aspects of the Program and this Agreement.

F. Each party shall promptly give the other written notice of any claim, lawsuit, or administrative proceeding concerning a claim for benefits under the Program or any other matter embraced by the indemnity. The parties shall cooperate fully in the defense of any such claim, lawsuit, or proceeding.

G. If litigation arises out of this Agreement, the prevailing party shall be entitled to recover legal expenses, including but not limited to, attorney's fees, pretrial discovery, deposition and investigation expenses, and other expenses reasonably and necessarily incurred in such litigation at the trial and appellate court levels.

TERM AND TERMINATION
A. Contract Years are successive twelve month periods computed from the Effective Date of this Agreement. The date of termination of this Agreement, unless otherwise specified, shall be deemed to be the last day of a Contract Year.

B. This Agreement may be terminated by either party upon sixty (60) days written notice of termination provided to the other party.

C. This Agreement will terminate automatically on the date of termination of any group long term disability insurance policy issued to Program Sponsor by Standard.

D. Program Sponsor's failure to pay Fees or to reimburse Standard pursuant to Benefit Payments And Reimbursements shall terminate this Agreement upon written notice by Standard to be delivered to Program Sponsor at its last known address.

E. Effect of Termination.

Administrative Services Agreement 764500
1) Claims Administration
Notwithstanding termination of this Agreement, the Standard may at its option continue to provide claim services with respect to any claim for benefits under the Program with an incurred date occurring on or before the date of termination. Program Sponsor shall see to it that any such claim is immediately sent to Standard.

Standard may administer any such claim until it determines the claim is inactive. The terms and provision of this Agreement shall continue to apply where applicable to the runoff of such claims, specifically including Program Sponsor's obligation to make funds available for payment of benefits. 2) Claims Records
Standard may retain any open or active claim files as provided in item E.1 above of the Term And Termination section of this Agreement. Any such files not retained by Standard shall be sent to Program Sponsor or its successor administrator promptly upon payment of Standard's reasonable shipping and handling costs.

Standard shall retain all inactive claim files and other records and reports relating to such claims and prepared and maintained by Standard pursuant to this Agreement, and may destroy such files, etc. as provided in Records and Claim File provision. Program Sponsor may obtain possession of such extant claim files, records and reports upon written request to Standard and payment of Standard's reasonable shipping and handling costs.

Program Sponsor acknowledges that locating and processing such files and records may be difficult and time consuming and may substantially increase the shipping and handling costs it is obligated to pay.

F. Outstanding Obligations
Notwithstanding any other provision of this Agreement to the contrary, the termination of this Agreement shall not release either party from any obligation already incurred, including any payment obligation already incurred under the Fees or Benefit Payments And Reimbursements provision. Further, provisions of the defense obligations under Obligation Of Program Sponsor and the confidentiality provisions under Records And Claim Files sections will not be affected by the termination of this Agreement and will remain in full force and effect.

IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed in duplicate by their respective officers duly authorized to do so.

Program Sponsor:

By ________________________________________________ Date _______________

STANDARD INSURANCE COMPANY
By
President and CEO Corporate Secretary
City Of Anaheim

PROGRAM DOCUMENT

SHORT TERM DISABILITY INCOME BENEFIT PROGRAM
Program Sponsor has established a short term disability income benefit Program and agreed to provide STD Benefits according to the terms of this Program Document. Program Sponsor is solely responsible for payment of STD Benefits payable under the terms of this Program.

Program Sponsor has retained Standard Insurance Company as Claims Administrator for the Program. Standard shall receive, process, investigate and evaluate claims for benefits. Standard has authority to make initial decisions to approve, deny or close claims for benefits. Standard is also authorized to review and decide appeals of denied or closed claims, if requested by claimants as provided in the appeal provision of the Program. Thereafter, Program Sponsor may elect to hear and decide any further appeals by claimants. In each case, Program Sponsor retains the right of final review and decision on all claims and appeals.

Standard will also perform certain administrative services for the Program, including advising and assisting Program Sponsor with preparation and revision of the Program and providing actuarial services. Standard has no authority or obligation with respect to management or investment of the assets of the Program or Program Sponsor's right of subrogation under the Program.

This Program and the individual applications, if any, of the Members constitute the entire Program. Program Sponsor has the right at any time to amend or terminate this Program or to require or change the amount of Member contributions. No change in this Program will be valid unless approved by Program Sponsor and evidenced by an amendment. No agent has authority to change this Program or to waive any of its provisions.

For purposes of effective dates and ending dates under this Program, all days begin and end at 12:00 midnight Standard Time at Program Sponsor's address.

All provisions on this and the following pages are part of this Program. "You" and "your" mean the Member. "We", "us", and "our" mean Standard Insurance Company acting in its capacity as Claims Administrator on behalf of the Program Sponsor. Other defined terms appear with their initial letters capitalized. Section headings, and references to them, appear in boldface type.

PROGRAM SPONSOR
By
Signature(s) and Title(s) of Authorized Representative(s) Table of Contents
COVERAGE FEATURES ................................................................................................................................................................. 1 GENERAL PROGRAM INFORMATION ........................................................................................................................... 1 SCHEDULE OF COVERAGE ................................................................................................................................................. 1 MEMBER CONTRIBUTIONS .............................................................................................................................................. 2 STATEMENT OF COVERAGE ...................................................................................................................................................... 3 BECOMING COVERED ................................................................................................................................................................... 3 WHEN YOUR COVERAGE BECOMES EFFECTIVE ............................................................................................................. 3 ACTIVE WORK PROVISIONS ...................................................................................................................................................... 3 WHEN YOUR COVERAGE ENDS ............................................................................................................................................... 3 REINSTATEMENT OF COVERAGE ........................................................................................................................................... 4 DEFINITION OF DISABILITY ..................................................................................................................................................... 4 RETURN TO WORK PROVISIONS ............................................................................................................................................ 5 TEMPORARY RECOVERY ............................................................................................................................................................ 6 WHEN STD BENEFITS END ........................................................................................................................................................ 6 PREDISABILITY EARNINGS ....................................................................................................................................................... 6 DEDUCTIBLE INCOME ................................................................................................................................................................. 7 EXCEPTIONS TO DEDUCTIBLE INCOME .............................................................................................................................. 7 RULES FOR DEDUCTIBLE INCOME ........................................................................................................................................ 8 SUBROGATION ................................................................................................................................................................................ 9 BENEFITS AFTER COVERAGE ENDS OR IS CHANGED ................................................................................................... 9 EFFECT OF NEW DISABILITY ................................................................................................................................................... 9 DISABILITIES EXCLUDED FROM COVERAGE .................................................................................................................... 9 LIMITATIONS ................................................................................................................................................................................ 10 CLAIMS ............................................................................................................................................................................................. 10 LIMITED AGENCY APPOINTMENT OF STANDARD ...................................................................................................... 12 TIME LIMITS ON LEGAL ACTIONS ....................................................................................................................................... 12 CLERICAL ERROR ........................................................................................................................................................................ 12 TERMINATION OR AMENDMENT OF THE PROGRAM ............................................................................................... 13 DEFINITIONS ................................................................................................................................................................................. 13 Index of Defined Terms
Active Work, Actively At Work, 3
Allowable Periods, 5
ASO Number, 1
Benefit Waiting Period, 2, 13
Claims Administrator, 1
Class Definition, 1
Contributory, 13
Deductible Income, 7
Disabled, 4
Eligibility Waiting Period, 1
Employer, 13
Employer(s), 1
Hospital, 13
Injury, 13
L.L.C. Owner-Employee, 13
Maximum Benefit Period, 2, 13
Member, 1, 3
Mental Disorder, 13
Noncontributory, 13
P.C. Partner, 13
Physical Disease, 13
Physician, 13
Plan Effective Date, 1
Plan Sponsor, 1
Predisability Earnings, 6
Pregnancy, 13
Prior Plan, 13
Proof Of Loss, 10
STD Benefit, 1, 13
Temporary Recovery, 5
War, 9
Work Earnings, 5
9/2026 - 1 - 764500

COVERAGE FEATURES
This section contains many of the features of your short term disability (STD) coverage. Other provisions, including exclusions, limitations, and Deductible Income appear in other sections. Please refer to the text of each section for full details. The Table of Contents and the Index of Defined Terms help locate sections and definitions.

GENERAL PROGRAM INFORMATION
Program Sponsor: City Of Anaheim
Employer(s): City Of Anaheim
Claims Administrator: Standard Insurance Company
ASO Number: 764500
Program Effective Date: January 1, 2027
Member means:

1. A regular employee of the Employer;

2. Actively At Work at least 40 hours each week (for purposes of the Member definition, Actively At Work will include regularly scheduled days off, holidays, or vacation days, so long as the person is capable of Active Work on those days); and

3. A citizen or resident of the United States or Canada.

Member does not include a temporary or seasonal employee, a full-time member of the armed forces of any country, a leased employee, or an independent contractor.

Class Definition:

Class 1: Fire Safety Members
Class 2: Police Association Members
Class 3: All other Members

SCHEDULE OF COVERAGE
Eligibility Waiting Period: You are eligible on one of the following dates:

If you are a Member on the Program Effective Date, you are eligible on that date.

If you become a Member after the Program Effective Date, you are eligible on the first day following 6 consecutive months as a Member.

Eligibility Waiting Period means the period you must be a Member before you become eligible for coverage.

STD Benefit: Class 1 and 3: 60% of your Predisability Earnings, reduced by Deductible Income.

Class 2: 85% of your Predisability Earnings, reduced by Deductible Income.
9/2026 - 2 - 764500
Benefit Waiting Period:

For Disability caused by
accidental Injury: Class 1: on the date following the 10th regularly scheduled work shift missed due to total disability
Class 2 and 3: 31 days
For Disability caused by Physical
Disease, Pregnancy or Mental Disorder: Class 1: on the date following the 10th regularly scheduled work shift missed due to total disability
Class 2 and 3: 31 days
Maximum Benefit Period: Class 1: 180 days
Class 2 and 3: 150 days
However, STD Benefits will end on the date long term disability benefits become payable to you under a group plan provided by your Employer, even if that occurs before the end of the Maximum Benefit Period.

If you are Disabled for less than one full week, one-fifth of the STD Benefit will be payable for each day of Disability.

MEMBER CONTRIBUTIONS
Coverage is: Noncontributory
9/2026 - 3 - 764500

STATEMENT OF COVERAGE
If you become Disabled while covered under the Program, STD Benefits will be payable according to the terms of the Program after we receive Proof Of Loss satisfactory to us. (ASO) ST.IC.OT.1

BECOMING COVERED
To become covered you must be a Member, complete your Eligibility Waiting Period, and meet the requirements in Active Work Provisions and When Your Coverage Becomes Effective.

You are a Member if you are:

1. A regular employee of the Employer;

2. Actively At Work at least 40 hours each week (for purposes of the Member definition, Actively At Work will include regularly scheduled days off, holidays, or vacation days, so long as you are capable of Active Work on those days); and

3. A citizen or resident of the United States or Canada.

You are not a Member if you are a temporary or seasonal employee, a full-time member of the armed forces of any country, a leased employee, or an independent contractor.

Eligibility Waiting Period means the period you must be a Member before you become eligible for coverage. Your Eligibility Waiting Period is shown in the Coverage Features. (ASO_VAR MBR DEF) ST.BI.OT.1

WHEN YOUR COVERAGE BECOMES EFFECTIVE
Subject to the Active Work Provisions, your coverage becomes effective on the date you become eligible. (VAR EOI_ASO_WITH 60 DAY PD) ST.EF.OT.3

ACTIVE WORK PROVISIONS
A. Active Work Requirement
You must be capable of Active Work on the day before the scheduled effective date of your coverage or your coverage will not become effective as scheduled. If you are incapable of Active Work because of Physical Disease, Injury, Pregnancy or Mental Disorder on the day before the scheduled effective date of your coverage, your coverage will not become effective until the day after you complete one full day of Active Work as an eligible Member.

Active Work and Actively At Work mean performing with reasonable continuity the Material Duties of your Own Occupation at your Employer's usual place of business.

B. Changes In Coverage
This Active Work requirement also applies to any increase in your coverage. (ASO) ST.AW.OT.1

WHEN YOUR COVERAGE ENDS
Your coverage ends automatically on the earliest of:

1. The date the last period ends for which a contribution was made for your coverage.

2. The date the Program terminates.

3. The date your employment terminates.
9/2026 - 4 - 764500

4. The date you cease to be a Member. However, your coverage will be continued during the following periods when you are absent from Active Work, unless it ends under any of the above. a. During the first 90 days of a temporary or indefinite administrative or involuntary leave of absence or sick leave, provided your Employer is paying you at least the same Predisability Earnings paid to you immediately before you ceased to be a Member. A period when you are absent from Active Work as part of a severance or other employment termination agreement is not a leave of absence, even if you are receiving the same Predisability Earnings.
b. During a leave of absence if continuation of your coverage under the Program is required by a state-mandated family or medical leave act or law.
c. During any other temporary leave of absence approved by your Employer in advance and in writing and scheduled to last the following or less:

Fire - 6 months
Police - 12 months
IBEW - 12 months
Unrep, AFSCME, AMEA - 6 months
A period of Disability is not a leave of absence.
d. During the Benefit Waiting Period and while STD Benefits are payable. (ASO) ST.EN.OT.1

REINSTATEMENT OF COVERAGE
If your coverage ends, you may become covered again as a new Member. However, the following will apply:

1. If you cease to be a Member because of a Disability that is not covered solely because of the exclusion for work related Disabilities, your coverage will end. However, if you become a Member again immediately after workers' compensation temporary benefits end, the Eligibility Waiting Period will be waived.

2. If your coverage ends because you cease to be a Member for any reason other than item 1 above, and if you become a Member again within 90 days, the Eligibility Waiting Period will be waived.

3. If your coverage ends because you are on a federal or state-mandated family or medical leave of absence, and you become a Member again immediately following the period allowed, your coverage will be reinstated pursuant to the federal or state-mandated family or medical leave act or law.

4. In no event will coverage be retroactive.
(ASO_NONOCC) ST.RE.OT.4

DEFINITION OF DISABILITY
You are Disabled if you meet the following Own Occupation definition of Disability:

You are required to be Disabled only from your Own Occupation. You are Disabled from your Own Occupation if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder:

1. You are unable to perform with reasonable continuity the Material Duties of your Own Occupation; and

2. You suffer a loss of at least 20% in your Predisability Earnings when working in your Own Occupation for your Employer.

You may work in another occupation while you meet the Own Occupation definition of Disability. However, you will no longer be Disabled when your Work Earnings from another occupation exceed 80% of your Predisability Earnings.

Your Work Earnings may be Deductible Income. See Return To Work Provisions and Deductible Income. 9/2026 - 5 - 764500
Own Occupation means the job you are regularly performing for your Employer when Disability begins.

Material Duties means the usual duties you perform in your regular job with your Employer, that cannot be reasonably modified or omitted. In no event will we consider working more than 8 hours per day or an average of more than 40 hours per week to be a Material Duty.
(OWN JOB DEF_WITH 40_WITH PARTL) ST.DD.AK.2

RETURN TO WORK PROVISIONS
A. Return To Work Responsibility
No STD Benefits will be paid for any period of Disability when you are able to work in your Own Occupation and able to earn at least 20% of your Predisability Earnings, but you elect not to work.

B. Return To Work Incentive
You may serve your Benefit Waiting Period while working if you meet the Own Occupation definition of Disability.

You are eligible for the Return To Work Incentive on the first day you work after the Benefit Waiting Period if STD Benefits are payable on that date.

Your Work Earnings will be Deductible Income as determined in 1., 2. and 3.

1. Determine the amount of your STD Benefit as if there were no Deductible Income, and add your Work Earnings to that amount.

2. Determine 100% of your Predisability Earnings.

3. If 1. is greater than 2., the difference will be Deductible Income.

C. Work Earnings Definition
Work Earnings means your gross weekly earnings from work you perform while Disabled, plus the earnings you could receive if you worked as much as you are able to, considering your Disability, in work that is reasonably available in your Own Occupation. Work Earnings includes sick pay, vacation pay, annual or personal leave pay or other salary continuation earned or accrued while working.

Earnings from work you perform will be included in Work Earnings when you have the right to receive them. If you are paid in a lump sum or on a basis other than weekly, we will prorate your Work Earnings over the period of time to which they apply. If no period of time is stated, we will use a reasonable one.

In determining your Work Earnings we:

1. Will use the financial accounting method you use for income tax purposes, if you use that method on a consistent basis.

2. Will not be limited to the taxable income you report to the Internal Revenue Service.

3. May ignore expenses under section 179 of the IRC as a deduction from your gross earnings.

4. May ignore depreciation as a deduction from your gross earnings.

5. May adjust the financial information you give us in order to clearly reflect your Work Earnings.

If we determine that your earnings vary substantially from week to week, we may determine your Work Earnings by averaging your earnings over the most recent four-week period. You will no longer be Disabled when your average Work Earnings over the last four weeks exceed 80% of your Predisability Earnings. (RTW RESP) ST.RW.OT.2
9/2026 - 6 - 764500

TEMPORARY RECOVERY
You may temporarily recover from your Disability during the Maximum Benefit Period, and then become Disabled again from the same cause or causes, without having to serve a new Benefit Waiting Period. Temporary Recovery means you cease to be Disabled for no longer than the applicable allowable period. See Definition Of Disability.

A. Allowable Period
The allowable period of recovery during the Maximum Benefit Period is: a total of 90 days of recovery.

B. Effect Of Temporary Recovery
If your Temporary Recovery does not exceed the Allowable Period, the following will apply.

1. The Predisability Earnings used to determine your STD Benefit will not change.

2. The period of Temporary Recovery will not count toward your Maximum Benefit Period.

3. No STD Benefits will be payable for the period of Temporary Recovery.

4. No STD Benefits will be payable after benefits become payable to you under any other disability coverage plan under which you become covered during your period of recovery.

5. Except as stated above, the provisions of the Program will be applied as if there had been no interruption of your Disability.
(ASO) ST.TR.OT.2

WHEN STD BENEFITS END
Your STD Benefits end automatically on the earliest of:

1. The date you are no longer Disabled.

2. The date your Maximum Benefit Period ends.

3. The date you die.

4. The date long term disability benefits become payable to you under a group long term disability insurance policy issued to Program Sponsor as policyholder, even if that occurs before the end of the Maximum Benefit Period.

5. The date benefits become payable to you under any other disability plan under which you become covered through employment during a period of Temporary Recovery.

6. The date you fail to provide proof of continued Disability and entitlement to STD Benefits. (ASO_REV LTD LIM) ST.BE.OT.3

PREDISABILITY EARNINGS
Your Predisability Earnings will be based on your earnings in effect on your last full day of Active Work. Any subsequent change in your earnings will not affect your Predisability Earnings.

Predisability Earnings means your weekly rate of earnings from your Employer, including:

1. Contributions you make through a salary reduction agreement with your Employer to:
a. An Internal Revenue Code (IRC) Section 401(k), 403(b), 408(k), 408(p), or 457 deferred compensation arrangement; or
b. An executive nonqualified deferred compensation arrangement.

2. Shift differential pay.
9/2026 - 7 - 764500

3. Amounts contributed to your fringe benefits according to a salary reduction agreement under an IRC Section 125 plan.

4. Hourly and biweekly incentive pay.

Predisability Earnings does not include:

1. Bonuses.

2. Commissions.

3. Overtime pay.

4. Stock options or stock bonuses.

5. Your Employer's contributions on your behalf to any deferred compensation arrangement or pension plan.

6. Any other extra compensation.

If you are paid on an annual contract basis, your weekly rate of earnings is one fifty-second (1/52nd) of your annual contract salary.

If you are paid hourly, your weekly rate of earnings is based on your hourly pay rate multiplied by the number of hours you are regularly scheduled to work per week, but not more than 40 hours. If you do not have regular work hours, your weekly rate of earnings is based on the average number of hours you worked per week during the preceding 52 weeks (or during your period of employment if less than 52 weeks), but not more than 40 hours. (REG NO COM_NO STOCK) ST.PD.OT.1

DEDUCTIBLE INCOME
Subject to Exceptions To Deductible Income, Deductible Income means:

1. Your Work Earnings, as described in the Return To Work Provisions.

2. Any amount you receive or are eligible to receive because of your disability under a state disability income benefit law or similar law.

3. Any amount you receive or are eligible to receive because of your disability under another group coverage.

4. Any disability or retirement benefits you receive under your Employer's retirement plan.

5. Any earnings or compensation included in Predisability Earnings which you receive or are eligible to receive while STD Benefits are payable.

6. Any amount you receive or are eligible to receive under any unemployment compensation law or similar act or law.

7. Any amount you receive or are eligible to receive from or on behalf of a third party because of your disability, whether by judgment, settlement or other method. If you notify us before filing suit or settling your claim against such third party, the amount used as Deductible Income will be reduced by a pro rata share of your costs of recovery, including reasonable attorney fees.

8. Any amount you receive by compromise, settlement, or other method as a result of a claim for any of the above, whether disputed or undisputed.
(ASO_PRIV_NONOCC_WITH RTW_100% SL_NO OTHR OFFST_WITH 3RD) ST.DI.OT.1X

EXCEPTIONS TO DEDUCTIBLE INCOME
Deductible Income does not include:

1. Any cost of living increase in any Deductible Income other than Work Earnings, if the increase becomes effective while you are Disabled and while you are eligible for the Deductible Income.

2. Reimbursement for hospital, medical, or surgical expense. 9/2026 - 8 - 764500

3. Reasonable attorneys fees incurred in connection with a claim for Deductible Income.

4. Benefits from any individual disability insurance policy.

5. Group credit or mortgage disability insurance benefits.

6. Accelerated death benefits paid under a life coverage plan or life insurance policy.

7. Benefits from the following:
a. Profit sharing plan.
b. Thrift or savings plan.
c. Deferred compensation plan.
d. Plan under IRC Section 401(k), 408(k), 408(p), or 457. e. Individual Retirement Account (IRA).
f. Tax Sheltered Annuity (TSA) under IRC Section 403(b). g. Stock ownership plan.
h. Keogh (HR-10) plan.

8. The following amounts under your Employer's retirement plan:
a. A lump sum distribution of your entire interest in the plan. b. Any amount which is attributable to your contributions to the plan. c. Any amount you could have received upon termination of employment without being disabled or retired. (ASO_PRIV_NO OTHR OFFST) ST.ED.OT.1

RULES FOR DEDUCTIBLE INCOME
A. Weekly Equivalents
Each week we will determine your STD Benefit using the Deductible Income for the same weekly period, even if you actually receive the Deductible Income in another week.

If you are paid Deductible Income in a lump sum or by a method other than weekly, we will determine your STD Benefit using a prorated amount. We will use the period of time to which the Deductible Income applies. If no period of time is stated, we will use a reasonable one.

B. Your Duty To Pursue Deductible Income
You must pursue Deductible Income for which you may be eligible. We may ask for written documentation of your pursuit of Deductible Income. You must provide it within 60 days after we mail you our request. Otherwise, we may reduce your STD Benefits by the amount we estimate you would be eligible to receive upon proper pursuit of the Deductible Income.

C. Pending Deductible Income
We will not deduct pending Deductible Income until it becomes payable. You must notify us of the amount of the Deductible Income when it is approved. You must repay us for the resulting overpayment of your claim.

D. Overpayment Of Claim
We will notify you of the amount of any overpayment of your claim under the Program. You must immediately repay any overpayment. You will not receive any STD Benefits until the overpayment has been repaid in full. In the meantime, any STD Benefits paid, including the Minimum STD Benefit, will be applied to reduce the amount of the overpayment. We may charge you interest at the legal rate for any overpayment which is not repaid within 30 days after we first mail you notice of the amount of the overpayment. 9/2026 - 9 - 764500
(ASO) ST.RU.OT.2

SUBROGATION
If STD Benefits are paid or payable to you under the Program as the result of any act or omission of a third party, Program Sponsor will be subrogated to all rights of recovery you may have in respect to such act or omission. You must avoid doing anything that would prejudice Program Sponsor's rights of subrogation.

If you notify Program Sponsor before filing suit or settling your claim against such third party, the amount to which Program Sponsor is subrogated will be reduced by a pro rata share of your costs of recovery, including reasonable attorney fees. If suit or action is filed, Program Sponsor may record a notice of payments of STD Benefits, and such notice shall constitute a lien on any judgment recovered.

If you or your legal representative fail to bring suit or action promptly against such third party, Program Sponsor may institute such suit or action in Program Sponsor's name or in your name. Program Sponsor is entitled to retain from any judgment recovered the amount of STD Benefits paid or to be paid to you or on your behalf, together with Program Sponsor's costs of recovery, including attorney fees. The remainder of such recovery, if any, shall be paid to you or as the court may direct.
(ASO) ST.SG.OT.1

BENEFITS AFTER COVERAGE ENDS OR IS CHANGED
During each period of continuous Disability, STD Benefits will be payable according to the terms of the Program in effect on the date you become Disabled. Your right to receive STD Benefits will not be affected by:

1. Any amendment to the Program that is effective after you become Disabled; or

2. Termination of the Program after you become Disabled.

ST.BA.OT.1

EFFECT OF NEW DISABILITY
If a period of Disability is extended by a new cause while STD Benefits are payable, STD Benefits will continue while you remain Disabled. However, 1 and 2 below will apply.

1. STD Benefits will not continue beyond the end of the original Maximum Benefit Period.

2. All provisions of the Program, including the Disabilities Excluded From Coverage and Limitations sections, will apply to the new cause of Disability.
(ASO) ST.ND.OT.1

DISABILITIES EXCLUDED FROM COVERAGE
A. War
You are not covered for a Disability caused or contributed to by War or any act of War. War means declared or undeclared war, whether civil or international, and any substantial armed conflict between organized forces of a military nature.

B. Intentionally Self-Inflicted Injury
You are not covered for a Disability caused or contributed to by an intentionally self-inflicted Injury, while sane or insane.

C. Work Related
You are not covered for a Disability arising out of or in the course of any employment for wage or profit.

D. Violent Or Criminal Conduct
9/2026 - 10 - 764500
You are not covered for a Disability caused or contributed to by your committing or attempting to commit an assault or felony, or actively participating in a violent disorder or riot. Actively participating does not include being at the scene of a violent disorder or riot while performing your official duties.

E. Loss Of License Or Certification
You are not covered for a Disability caused or contributed to by the loss of your professional license, occupational license or certification.
(NONOCC) ST.XD.OT.1

LIMITATIONS
A. Care Of A Physician
You must be under the ongoing care of a Physician in the appropriate specialty as determined by us during the Benefit Waiting Period. No STD Benefits will be paid for any period of Disability when you are not under the ongoing care of a Physician in the appropriate specialty as determined by us.

B. Occupational Benefits
No STD Benefits will be paid for any period when you are eligible to receive benefits for your Disability under a workers' compensation law or similar law. If your claim for these benefits is accepted, compromised or settled (whether disputed or undisputed), you must repay us for the full amount of any payments Program Sponsor makes to you while your claim for occupational benefits is pending.

C. Imprisonment
No STD Benefits will be paid for any period of Disability when you are confined for any reason in a penal or correctional institution.

D. Return To Work Responsibility
No STD Benefits will be paid for any period of Disability when you are able to work in your Own Occupation and able to earn at least 20% of your Predisability Earnings, but you elect not to work.

E. Rehabilitation Program
No STD Benefits will be paid for any period of Disability when you are not participating in good faith in a plan, program or course of medical treatment or vocational training or education approved by us unless your Disability prevents you from participating.
(ASO_NONOCC_RTW RSP_MAND REHB) ST.LM.OT.1
CLAIMS
A. Filing A Claim
Claims should be filed on our forms. If you do not receive our forms within 15 days after you ask for them, you may submit your claim in a letter to us. The letter should include the date Disability began, and the cause and nature of the Disability.

B. Time Limits On Filing Proof Of Loss
You must give us Proof Of Loss within 90 days after the end of the Benefit Waiting Period. If you cannot do so, you must give it to us as soon as reasonably possible, but not later than one year after that 90-day period. If Proof Of Loss is filed outside these time limits, your claim will be denied. These limits will not apply while you lack legal capacity.

C. Proof Of Loss
Proof Of Loss means written proof that you are Disabled and entitled to STD Benefits. Proof Of Loss must be provided at your expense.
9/2026 - 11 - 764500
For claims of Disability due to conditions other than Mental Disorders, we may require proof of physical impairment that results from anatomical or physiological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques.

D. Documentation
Completed claims statements, a signed authorization for us to obtain information, and any other items we may reasonably require in support of a claim must be submitted at your expense. If the required documentation is not provided within 45 days after we mail our request, your claim may be denied.

E. Investigation Of Claim
We may investigate your claim at any time.

At our expense, we may have you examined at reasonable intervals by specialists of our choice. We may deny or suspend STD Benefits if you fail to attend an examination or cooperate with the examiner.

F. Time Of Payment
Program Sponsor will pay STD Benefits within 60 days after you satisfy Proof Of Loss.

STD Benefits will be paid to you at the end of each week you qualify for them. STD Benefits remaining unpaid at your death will be paid to your estate.

G. Notice Of Decision On Claim
We will evaluate your claim promptly after you file it. Within 45 days after we receive your claim we will send you:
(a) a written decision on your claim; or (b) a notice that we are extending the period to decide your claim for 30 days. Before the end of this extension period we will send you: (a) a written decision on your claim; or (b) a notice that we are extending the period to decide your claim for an additional 30 days. If an extension is due to your failure to provide information necessary to decide the claim, the extended time period for deciding your claim will not begin until you provide the information or otherwise respond.

If we extend the period to decide your claim, we will notify you of the following: (a) the reasons for the extension; (b) when we expect to decide your claim; (c) an explanation of the standards on which entitlement to benefits is based; (d) the unresolved issues preventing a decision; and (e) any additional information we need to resolve those issues.

If we request additional information, you will have 45 days to provide the information. If you do not provide the requested information within 45 days, we may decide your claim based on the information we have received.

If we deny any part of your claim, you will receive a written notice of denial containing:
a. The reasons for our decision.
b. Reference to the parts of the Program on which our decision is based. c. A description of any additional information needed to support your claim.

H. Review Procedure
If all or part of a claim is denied, you may request a review. You must request a review in writing within 180 days after receiving notice of the denial.

You may send us written comments or other items to support your claim. You may review and receive copies of any non-privileged information that is relevant to your request for review. There will be no charge for such copies.

You may request the names of medical or vocational experts who provided advice to us about your claim.

The person conducting the review will be someone other than the person who denied the claim and will not be subordinate to that person. The person conducting the review will not give deference to the initial denial decision.

If the denial was based on a medical judgment, the person conducting the review will consult with a qualified health care professional. This health care professional will be someone other than the person who made the original medical judgment and will not be subordinate to that person. Our review will include any written comments or other items you submit to support your claim.
9/2026 - 12 - 764500
We will review your claim promptly after we receive your request. Within 45 days after we receive your request for review we will send you: (a) a written decision on review; or (b) a notice that we are extending the review period for 45 days. If the extension is due to your failure to provide information necessary to decide the claim on review, the extended time period for review of your claim will not begin until you provide the information or otherwise respond.

If we extend the review period, we will notify you of the following: (a) the reasons for the extension; (b) when we expect to decide your claim on review; and (c) any additional information we need to decide your claim.

If we request additional information, you will have 45 days to provide the information. If you do not provide the requested information within 45 days, we may conclude our review of your claim based on the information we have received.

If we deny any part of your claim on review, you will receive a written notice of denial containing:
a. The reasons for our decision.
b. Reference to the parts of the Program on which our decision is based. c. Information concerning your right to receive, free of charge, copies of non-privileged documents and records relevant to your claim.

I. Assignment
The rights and benefits under the Program are not assignable. (ASO_REV PRIV WRDG) ST.CL.OT.2

LIMITED AGENCY APPOINTMENT OF STANDARD
Program Sponsor has appointed Standard to act on its behalf as Claims Administrator for the Program and grants Standard authority to fulfill the Obligations of Claim Administration as provided herein. Standard is empowered to act on behalf of Program Sponsor in connection with the Program only as expressly stated in this Program. Standard has no authority or obligation with respect to (1) an Program Sponsor's right of subrogation under the Program, or (2) management or investment of the assets of the Program. In performing its obligations under this Agreement, Standard is acting solely as the agent of Program Sponsor.

Standard's decisions are subject to the review procedures of the Program Sponsor. (ASO) ST.AP.OT.1

TIME LIMITS ON LEGAL ACTIONS
No action at law or in equity may be brought until 60 days after you have given us Proof Of Loss. No such action may be brought more than three years after the earlier of:

1. The date we receive Proof Of Loss; and

2. The time within which Proof Of Loss is required to be given. (ASO) ST.TL.OT.1

CLERICAL ERROR
Clerical error by Program Sponsor, your Employer, Claims Administrator, or their respective employees or representatives will not:

1. Cause a person to become covered.

2. Invalidate coverage under the Program otherwise validly in force.

3. Continue coverage under the Program otherwise validly terminated. 9/2026 - 13 - 764500
(ASO) ST.CE.OT.2

TERMINATION OR AMENDMENT OF THE PROGRAM
Program Sponsor may terminate the Program in whole, and may terminate coverage for any class or group of Members, at any time.

Benefits under the Program are limited to its terms, including any valid amendment. No change or amendment will be valid unless approved by Program Sponsor and evidenced by an amendment.

No agent has authority to change or amend the Program or to waive any of its terms or provisions.

Any such change or amendment of the Program may apply to current or future Members or to any separate classes or groups of Members.
(ASO) ST.TA.OT.2

DEFINITIONS
Benefit Waiting Period means the period you must be continuously Disabled before STD Benefits become payable. No STD Benefits are payable for the Benefit Waiting Period. See Coverage Features.

Contributory means coverage under the Program is elective and Members pay all or part of the cost of coverage.

Employer means an employer (including approved affiliates and subsidiaries) for which coverage under the Program is approved in writing by us.

Hospital means a legally operated hospital providing full-time medical care and treatment under the direction of a fulltime staff of licensed physicians. Rest homes, nursing homes, convalescent homes, homes for the aged, and facilities primarily affording custodial, educational, or rehabilitative care are not Hospitals.

Injury means an injury to the body.

L.L.C. Owner-Employee means an individual who owns an equity interest in an Employer and is actively employed in the conduct of the Employer's business.

Maximum Benefit Period means the longest period for which STD Benefits are payable for any one period of continuous Disability, whether from one or more causes. It begins at the end of the Benefit Waiting Period. No STD Benefits are payable after the end of the Maximum Benefit Period, even if you are still Disabled. See Coverage Features.

Mental Disorder means any mental, emotional, behavioral, psychological, personality, cognitive, mood or stress-related abnormality, disorder, disturbance, dysfunction or syndrome, regardless of cause (including any biological or biochemical disorder or imbalance of the brain) or the presence of physical symptoms. Mental Disorder includes, but is not limited to, bipolar affective disorder, organic brain syndrome, schizophrenia, psychotic illness, manic depressive illness, depression and depressive disorders, anxiety and anxiety disorders.

Noncontributory means (a) coverage under the Program is nonelective and Program Sponsor or the Employer pay the entire cost of coverage; or (b) Program Sponsor requires all eligible Members who meet the Active Work requirements to have coverage and to pay all or part of the cost of coverage.

P.C. Partner means the sole active employee and majority shareholder of a professional corporation in partnership with Program Sponsor.

Physical Disease means a physical disease entity or process that produces structural or functional changes in your body as diagnosed by a Physician.

Physician means a licensed M.D. or D.O., acting within the scope of the license. Physician does not include you or your spouse, or the brother, sister, parent, or child of either you or your spouse.

Pregnancy means your pregnancy, childbirth, or related medical conditions, including complications of pregnancy.

Prior Plan means your Employer's short term disability Program in effect on the day before the effective date of your Employer's coverage under the Program and which is replaced by the Program. 9/2026 - 14 - 764500
Program means the group short term disability income benefit Program established by Program Sponsor and identified by the ASO Number.

STD Benefit means the weekly benefit payable to you under the terms of the Program. (ASO) ST.DF.OT.1
CA/STDP2000 (ASO)

NOTICE OF PROTECTION PROVIDED BY

CALIFORNIA LIFE AND HEALTH INSURANCE GUARANTEE ASSOCIATION This notice provides a brief summary regarding the protections provided to policyholders by the California Life and Health Insurance Guarantee Association ("the Association"). The purpose of the Association is to assure that policyholders will be protected, within certain limits, in the unlikely event that a member insurer of the Association becomes financially unable to meet its obligations. Insurance companies licensed in California to sell life insurance, health insurance, annuities and structured settlement annuities are members of the Association. The protection provided by the Association is not unlimited and is not a substitute for consumers’ care in selecting insurers. This protection was created under California law, which determines who and what is covered and the amounts of coverage.

Below is a brief summary of the coverages, exclusions and limits provided by the Association. This summary does not cover all provisions of the law; nor does it in any way change anyone’s rights or obligations or the rights or obligations of the Association.

COVERAGE
 Persons Covered
Generally, an individual is covered by the Association if the insurer was a member of the Association and the individual lives in California at the time the insurer is determined by a court to be insolvent. Coverage is also provided to policy beneficiaries, payees or assignees, whether or not they live in California.  Amounts of Coverage
The basic coverage protections provided by the Association are as follows.  Life Insurance, Annuities and Structured Settlement Annuities For life insurance policies, annuities and structured settlement annuities, the Association will provide the following:
 Life Insurance
80% of death benefits but not to exceed $300,000
80% of cash surrender or withdrawal values but not to exceed $100,000  Annuities and Structured Settlement Annuities
80% of the present value of annuity benefits, including net cash withdrawal and net cash surrender values but not to exceed $250,000
The maximum amount of protection provided by the Association to an individual, for all life insurance, annuities and structured settlement annuities is $300,000, regardless of the number of policies or contracts covering the individual.
 Health Insurance
The maximum amount of protection provided by the Association to an individual, as of July 1, 2016, is $546,741.

This amount will increase or decrease based upon changes in the health care cost component of the consumer price index to the date on which an insurer becomes an insolvent insurer. Changes to this amount will be posted on the Association’s website www.califega.org.

COVERAGE LIMITATIONS AND EXCLUSIONS FROM COVERAGE
The Association may not provide coverage for this policy. Coverage by the Association generally requires residency in California. You should not rely on coverage by the Association in selecting an insurance company or in selecting an insurance policy.

The following policies and persons are among those that are excluded from Association coverage:
 A policy or contract issued by an insurer that was not authorized to do business in California when it issued the policy or contract
 A policy issued by a health care service plan (HMO), a hospital or medical service organization, a charitable organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company, an insurance exchange, or a grants and annuities society
 If the person is provided coverage by the guaranty association of another state  Unallocated annuity contracts; that is, contracts which are not issued to and owned by an individual and which do not guaranty annuity benefits to an individual
 Employer and association plans, to the extent they are self-funded or uninsured  A policy or contract providing any health care benefits under Medicare Part C or Part D  An annuity issued by an organization that is only licensed to issue charitable gift annuities  Any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as certain investment elements of a variable life insurance policy or a variable annuity contract  Any policy of reinsurance unless an assumption certificate was issued  Interest rate yields (including implied yields) that exceed limits that are specified in Insurance Code Section 1067.02(b)(2)(C).

NOTICES
Insurance companies or their agents are required by law to give or send you this notice. Policyholders with additional questions should first contact their insurer or agent. To learn more about coverages provided by the Association, please visit the Association’s website at www.califega.org, or contact either of the following:

California Life and Health Insurance California Department of Insurance Guarantee Association Consumer Communications Bureau
PO Box 16860 300 South Spring Street
Beverly Hills, CA 90209-3319 Los Angeles CA 90013
(323) 782-0182 (800) 927-4357
Insurance companies and agents are not allowed by California law to use the existence of the Association or its coverage to solicit, induce or encourage you to purchase any form of insurance. When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between this notice and California law, then California law will control.

CALIFORNIA NOTICE OF COMPLAINT PROCEDURE
Should any dispute arise about your premium or about a claim that you have filed, write to the company that issued the group policy at:

Standard Insurance Company
PO Box 711
Portland, OR 97207
(503) 321-7000
If the problem is not resolved, you may also write to the State of California at:

Department of Insurance
Consumer Services Division
300 S. Spring Street, 9th FL
Los Angeles, CA 90013
1-800-927-HELP (4357)
www.insurance.ca.gov/0500-about-us/02-department/030-csmcb/consumer-services.cfm This notice of complaint procedure is for information only and does not become a part or condition of this group policy/certificate.

STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282
(503) 321-7000

GROUP LONG TERM DISABILITY INSURANCE POLICY
Policyholder: City Of Anaheim
Policy Number: 764999
Effective Date: January 1, 2027
The consideration for this Group Policy is the application of the Policyholder and the payment by the Policyholder of premiums as provided herein.

Subject to the Policyholder Provisions and the Incontestability Provisions, this Group Policy (a) is issued for the Initial Rate Guarantee Period shown in the Coverage Features, and (b) may be renewed for successive renewal periods by the payment of the premium set by us on each renewal date. The length of each renewal period will be set by us, but will not be less than 12 months.

For purposes of effective dates and ending dates under this Group Policy, all days begin and end at 12:00 midnight Standard Time at the Policyholder's address.

All provisions on this and the following pages are part of this Group Policy. "You" and "your" mean the Member. "We", "us", and "our" mean Standard Insurance Company. Other defined terms appear with their initial letters capitalized.

Section headings, and references to them, appear in boldface type.

STANDARD INSURANCE COMPANY
By
President and CEO Corporate Secretary
GP190-LTD/S399
Table of Contents
COVERAGE FEATURES ................................................................................................................................................................. 1 GENERAL POLICY INFORMATION ................................................................................................................................. 1 SCHEDULE OF INSURANCE ............................................................................................................................................... 1 PREMIUM CONTRIBUTIONS ............................................................................................................................................. 2 PREMIUM AND RENEWALS .............................................................................................................................................. 2 INSURING CLAUSE ......................................................................................................................................................................... 3 BECOMING INSURED .................................................................................................................................................................... 3 WHEN YOUR INSURANCE BECOMES EFFECTIVE ........................................................................................................... 3 ACTIVE WORK PROVISIONS ...................................................................................................................................................... 3 CONTINUITY OF COVERAGE ..................................................................................................................................................... 4 WHEN YOUR INSURANCE ENDS.............................................................................................................................................. 4 WAIVER OF PREMIUM ................................................................................................................................................................. 5 REINSTATEMENT OF INSURANCE ......................................................................................................................................... 5 DEFINITION OF DISABILITY ..................................................................................................................................................... 5 RETURN TO WORK PROVISIONS ............................................................................................................................................ 6 REASONABLE ACCOMMODATION EXPENSE BENEFIT................................................................................................. 8 REHABILITATION PLAN PROVISION .................................................................................................................................... 8 TEMPORARY RECOVERY ............................................................................................................................................................ 8 WHEN LTD BENEFITS END ....................................................................................................................................................... 9 PREDISABILITY EARNINGS ....................................................................................................................................................... 9 DEDUCTIBLE INCOME .............................................................................................................................................................. 10 EXCEPTIONS TO DEDUCTIBLE INCOME ........................................................................................................................... 11 RULES FOR DEDUCTIBLE INCOME ..................................................................................................................................... 12 SURVIVORS BENEFIT ................................................................................................................................................................ 13 BENEFITS AFTER INSURANCE ENDS OR IS CHANGED .............................................................................................. 13 EFFECT OF NEW DISABILITY ................................................................................................................................................ 13 DISABILITIES EXCLUDED FROM COVERAGE ................................................................................................................. 13 LIMITATIONS ................................................................................................................................................................................ 14 CLAIMS ............................................................................................................................................................................................. 16 TIME LIMITS ON LEGAL ACTIONS ....................................................................................................................................... 19 INCONTESTABILITY PROVISIONS ....................................................................................................................................... 19 CLERICAL ERROR, AGENCY, AND MISSTATEMENT .................................................................................................... 19 TERMINATION OR AMENDMENT OF THE GROUP POLICY...................................................................................... 20 DEFINITIONS ................................................................................................................................................................................. 20 POLICYHOLDER PROVISIONS ................................................................................................................................................ 21 Index of Defined Terms
Active Work, Actively At Work, 4
Allowable Periods, 9
Any Occupation Period, 1
Benefit Waiting Period, 2, 21
Child, 8
Class Definition, 1
Contributory, 21
CPI-W, 21
Deductible Income, 11
Domestic Partner, 22
Eligibility Waiting Period, 1
Employer, 21
Employer(s), 1
Evidence Of Insurability, 4
Family Care Expenses, 8
Family Member, 8
Grace Period, 23
Group Policy, 21
Group Policy Effective Date, 1
Group Policy Number, 1
Guarantee Issue Amount, 2, 4
Hospital, 16
Indexed Predisability Earnings, 21
Initial Rate Guarantee Period, 2
Injury, 21
L.L.C. Owner-Employee, 21
LTD Benefit, 21
Maximum Benefit Period, 2, 21
Maximum LTD Benefit, 2
Member, 1, 3
Mental Disorder, 15
Minimum LTD Benefit, 2
Minimum Participation Number, 2
Minimum Participation Percentage, 2
Noncontributory, 22
Own Occupation Period, 1
P.C. Partner, 22
Physical Disease, 22
Physician, 22
Policyholder, 1
Predisability Earnings, 10
Preexisting Condition means, 14
Pregnancy, 22
Premium Due Dates, 2
Premium Rates, 2
Prior Plan, 22
Reasonable Accommodation Expense Benefit,
8 Rehabilitation Plan, 9
Social Security Normal Retirement Age
(SSNRA), 2
Spouse, 22
Survivors Benefit, 14
Temporary Recovery, 9
War, 14
Work Earnings, 7
9/2026 - 1 - 764999

COVERAGE FEATURES
This section contains many of the features of your long term disability (LTD) insurance. Other provisions, including exclusions, limitations, and Deductible Income, appear in other sections. Please refer to the text of each section for full details. The Table of Contents and the Index of Defined Terms help locate sections and definitions.

GENERAL POLICY INFORMATION
Group Policy Number: 764999
Policyholder: City Of Anaheim
Employer(s): City Of Anaheim
Group Policy Effective Date: January 1, 2027
Policy Issued in: California
Member means:

1. A regular employee of the Employer, other than an AFA or fire safety employee;

2. Actively At Work at least 40 hours each week (for purposes of the Member definition, Actively At Work will include regularly scheduled days off, holidays, or vacation days, so long as the person is capable of Active Work on those days); and

3. A citizen or resident of the United States or Canada.

Member does not include a temporary or seasonal employee, a full-time member of the armed forces of any country, a leased employee, or an independent contractor.

Class Definition:

Class 1: Members other than Police Association Members
Class 2: Police Association Members

SCHEDULE OF INSURANCE
Eligibility Waiting Period: You are eligible on one of the following dates:

If you are a Member on the Group Policy Effective Date, you are eligible on that date.

If you become a Member after the Group Policy Effective Date, you are eligible on the first day following 6 consecutive months as a Member.

Eligibility Waiting Period means the period you must be a Member before you become eligible for insurance.

Own Occupation Period: The first 24 months for which LTD Benefits are paid.

Any Occupation Period: From the end of the Own Occupation Period to the end of the Maximum Benefit Period.

LTD Benefit: 60% of the first $21,667 of your Predisability Earnings, reduced by Deductible Income.
9/2026 - 2 - 764999
Maximum: $13,000 before reduction by Deductible Income.

Minimum: $100
Benefit Waiting Period: 180 days.

Maximum Benefit Period: Determined by your age when Disability begins, as follows:

Age Maximum Benefit Period
61 or younger ................................................................... To age 65, or to SSNRA, or 3 years 6 months, whichever is longest. 62 ........................................................................................... To SSNRA, or 3 years 6 months, whichever is longer. 63 ........................................................................................... To SSNRA, or 3 years, whichever is longer. 64 ........................................................................................... To SSNRA, or 2 years 6 months, whichever is longer. 65 ........................................................................................... 2 years 66 ........................................................................................... 1 year 9 months 67 ........................................................................................... 1 year 6 months 68 ........................................................................................... 1 year 3 months 69 or older ......................................................................... 1 year Social Security Normal Retirement Age (SSNRA) means your normal retirement age under the Federal Social Security Act, as amended.

PREMIUM CONTRIBUTIONS
Coverage is: Noncontributory

PREMIUM AND RENEWALS
Premium Rates: Class 1: 0.251% of the first $21,667 of insured Predisability Earnings of each insured Member.

Class 2: 0.290% of the first $21,667 of insured Predisability Earnings of each insured Member.

Premium Due Dates: January 1, 2027, and the first day of each calendar month thereafter.

Initial Rate Guarantee Period: January 1, 2027, to January 1, 2030 Minimum Participation Number: 10 insured Members
Minimum Participation Percentage: 100% of eligible Members 9/2026 - 3 - 764999

INSURING CLAUSE
If you become Disabled while insured under the Group Policy, we will pay LTD Benefits according to the terms of the Group Policy after we receive Proof Of Loss.

LT.IC.CA.1

BECOMING INSURED
To become insured you must be a Member, complete your Eligibility Waiting Period, and meet the requirements in Active Work Provisions and When Your Insurance Becomes Effective.

You are a Member if you are:

1. A regular employee of the Employer, other than an AFA or fire safety employee;

2. Actively At Work at least 40 hours each week (for purposes of the Member definition, Actively At Work will include regularly scheduled days off, holidays, or vacation days, so long as you are capable of Active Work on those days); and

3. A citizen or resident of the United States or Canada.

You are not a Member if you are a temporary or seasonal employee, a full-time member of the armed forces of any country, a leased employee, or an independent contractor.

Eligibility Waiting Period means the period you must be a Member before you become eligible for insurance. Your Eligibility Waiting Period is shown in the Coverage Features. (VAR MBR DEF) LT.BI.OT.1

WHEN YOUR INSURANCE BECOMES EFFECTIVE
A. When Insurance Becomes Effective
Subject to the Active Work Provisions, your insurance becomes effective on the date you become eligible.

B. Takeover Provision
If you were insured under the Prior Plan on the day before the effective date of your Employer's coverage under the Group Policy, your Eligibility Waiting Period is waived on the effective date of your Employer's coverage under the Group Policy.

LT.EF.OT.1X

ACTIVE WORK PROVISIONS
A. Active Work Requirement
You must be capable of Active Work on the day before the scheduled effective date of your insurance or your insurance will not become effective as scheduled. If you are incapable of Active Work because of Physical Disease, Injury, Pregnancy or Mental Disorder on the day before the scheduled effective date of your insurance, your insurance will not become effective until the day after you complete one full day of Active Work as an eligible Member.

Active Work and Actively At Work mean performing with reasonable continuity the Substantial And Material Acts of your Own Occupation at your Employer's usual place of business.

B. Changes In Insurance
This Active Work requirement also applies to any increase in your insurance.

LT.AW.CA.1
9/2026 - 4 - 764999

CONTINUITY OF COVERAGE
If your Disability is subject to the Preexisting Condition Exclusion, LTD Benefits will be payable if:

1. You were insured under the Prior Plan on the day before the effective date of your Employer's coverage under the Group Policy;

2. You became insured under the Group Policy when your insurance under the Prior Plan ceased;

3. You were continuously insured under the Group Policy from the effective date of your insurance under the Group Policy through the date you became Disabled from the Preexisting Condition; and

4. Benefits would have been payable under the terms of the Prior Plan if it had remained in force, taking into account the preexisting condition exclusion, if any, of the Prior Plan.

For such a Disability, the amount of your LTD Benefit will be the lesser of:
a. The monthly benefit that would have been payable under the terms of the Prior Plan if it had remained in force; or
b. The LTD Benefit payable under the terms of the Group Policy, but without application of the Preexisting Condition Exclusion.

Your LTD Benefits for such a Disability will end on the earlier of the following dates:
a. The date benefits would have ended under the terms of the Prior Plan if it had remained in force; or b. The date LTD Benefits end under the terms of the Group Policy. (PX) LT.CC.OT.1

WHEN YOUR INSURANCE ENDS
Your insurance ends automatically on the earliest of:

1. The date the last period ends for which a premium contribution was made for your insurance.

2. The date the Group Policy terminates.

3. The date your employment terminates.

4. The date you cease to be a Member. However, your insurance will be continued during the following periods when you are absent from Active Work, unless it ends under any of the above. a. During the first 90 days of a temporary or indefinite administrative or involuntary leave of absence or sick leave, provided your Employer is paying you at least the same Predisability Earnings paid to you immediately before you ceased to be a Member. A period when you are absent from Active Work as part of a severance or other employment termination agreement is not a leave of absence, even if you are receiving the same Predisability Earnings.
b. During a leave of absence if continuation of your insurance under the Group Policy is required by a statemandated family or medical leave act or law. c. During any other temporary leave of absence approved by your Employer in advance and in writing and scheduled to last 180 days or less. A period of Disability is not a leave of absence. d. During the period you are absent from Active Work due to a regularly scheduled school break or vacation. e. During the Benefit Waiting Period.

LT.EN.CA.1
9/2026 - 5 - 764999

WAIVER OF PREMIUM
We will waive payment of premium for your insurance while LTD Benefits are payable.

LT.WP.OT.1

REINSTATEMENT OF INSURANCE
If your insurance ends, you may become insured again as a new Member. However, the following will apply:

1. If you cease to be a Member because of a covered Disability following the Benefit Waiting Period, your insurance will end; however, if you become a Member again immediately after LTD Benefits end, the Eligibility Waiting Period will be waived and, with respect to the condition(s) for which LTD Benefits were payable, the Preexisting Condition Exclusion will be applied as if your insurance had remained in effect during that period of Disability.

2. If your insurance ends because you cease to be a Member for any reason other than a covered Disability, and if you become a Member again within 90 days, the Eligibility Waiting Period will be waived.

3. If your insurance ends because you are on a federal or state-mandated family or medical leave of absence, and you become a Member again immediately following the period allowed, your insurance will be reinstated pursuant to the federal or state-mandated family or medical leave act or law.

4. The Preexisting Conditions Exclusion will be applied as if insurance had remained in effect in the following instances:
a. If you become insured again within 90 days.
b. If required by federal or state-mandated family or medical leave act or law and you become insured again immediately following the period allowed under the family or medical leave act or law.

5. In no event will insurance be retroactive.

LT.RE.OT.2

DEFINITION OF DISABILITY
You are Disabled if you meet the following definitions during the periods they apply:

A. Own Occupation Definition Of Disability.

B. Any Occupation Definition Of Disability.

A. Own Occupation Definition Of Disability
During the Benefit Waiting Period and the Own Occupation Period you are required to be Totally Disabled from your Own Occupation or Partially Disabled from your Own Occupation.

1. Total Disability Definition: You are Totally Disabled from your Own Occupation if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder, you are unable to perform with reasonable continuity the Substantial And Material Acts necessary to pursue your Own Occupation and you are not working in your Own Occupation.

2. Partial Disability Definition: You are Partially Disabled from your Own Occupation if you are not Totally Disabled and you are actually working in your Own Occupation but, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder, you are unable to earn 80% or more of your Indexed Predisability Earnings.

Note: You are not Disabled from your Own Occupation merely because your right to perform your Own Occupation is restricted, including a restriction or loss of license. The loss of a professional license, occupational license, or certification does not, in itself, constitute Disability.

During the Own Occupation Period you may work in another occupation while you meet the Own Occupation definition of Disability. However, your Work Earnings may be Deductible Income and LTD Benefits will end when 9/2026 - 6 - 764999
your Work Earnings meet or exceed 80% of your Indexed Predisability Earnings. See Return To Work Provisions, Deductible Income, and When LTD Benefits End.

Own Occupation may be interpreted to mean the employment, business, trade or profession that involves the Substantial And Material Acts of the occupation you are regularly performing for your Employer when Disability begins. Own Occupation is not necessarily limited to the specific job you perform for your Employer.

Substantial And Material Acts means the important tasks, functions and operations generally required by employers from those engaged in your Own Occupation that cannot be reasonably omitted or modified. In determining what Substantial And Material Acts are necessary to pursue your Own Occupation, we will first look at the specific duties required by your job. If you are unable to perform one or more of these duties with reasonable continuity, we will then determine whether those duties are customarily required of other individuals engaged in your Own Occupation. If any specific, material duties required of you by your job differ from the material duties customarily required of other individuals engaged in your Own Occupation, then we will not consider those duties in determining what Substantial And Material Acts are necessary to pursue your Own Occupation Your Own Occupation Period is shown in the Coverage Features.

B. Any Occupation Definition Of Disability
During the Any Occupation Period you are required to be Totally Disabled from all occupations or Partially Disabled.

1. Total Disability Definition: You are Totally Disabled from all occupations if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder, you are unable to engage with reasonable continuity in Any Occupation.

2. Partial Disability Definition: You are Partially Disabled if you are not Totally Disabled and you are actually working in an occupation but, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder, you are unable to engage with reasonable continuity in that occupation or Any Occupation.

Any Occupation means all occupations or employment which you could reasonably be expected to perform satisfactorily in light of your age, education, training, experience, station in life, and physical and mental capacity that exists within any of the following locations: (i) a reasonable distance or travel time from your residence in light of the commuting practices of your community; or (ii) a distance or travel time equivalent to the distance or travel time you traveled to work before becoming Disabled; or (iii) the regional labor market, if you reside or resided prior to becoming Disabled in a metropolitan area.

Your Any Occupation Period is shown in the Coverage Features. (OWN_ANY) LT.DD.CA.1

RETURN TO WORK PROVISIONS
A. Return To Work Incentive
You may serve your Benefit Waiting Period while working if you meet the Own Occupation Definition Of Disability.

You are eligible for the Return To Work Incentive on the first day you work after the Benefit Waiting Period if LTD Benefits are payable on that date. The Return To Work Incentive changes 12 months after that date, as follows:

1. During the first 12 months, your Work Earnings will be Deductible Income as determined in a., b. and c:
a. Determine the amount of your LTD Benefit as if there were no Deductible Income, and add your Work Earnings to that amount.
b. Determine 100% of your Indexed Predisability Earnings. c. If a. is greater than b., the difference will be Deductible Income.

2. After those first 12 months, 50% of your Work Earnings will be Deductible Income.

B. Work Earnings Definition
9/2026 - 7 - 764999
Work Earnings means your gross monthly earnings from work you perform while Disabled. Work Earnings includes:

1. Earnings from your Employer.

2. Earnings from any other employer or self employment for which you become employed after the date of your Disability.

3. Any increases, except regularly scheduled increases, in earnings from employment from any other employer or self employment in which you were engaged prior to the date of your Disability.

4. Any sick pay, vacation pay, annual or personal leave pay, severance pay, or other salary continuation earned or accrued while working.

Earnings from work you perform will be included in Work Earnings when you have the right to receive them. If you are paid in a lump sum or on a basis other than monthly, we will prorate your Work Earnings over the period of time to which they apply. If no period of time is stated, we will use a reasonable one.

In determining your Work Earnings we:

1. Will use the financial accounting method you use for income tax purposes, if you use that method on a consistent basis.

2. Will not be limited to the taxable income you report to the Internal Revenue Service.

3. May ignore expenses under section 179 of the IRC as a deduction from your gross earnings.

4. May ignore depreciation as a deduction from your gross earnings.

5. May adjust the financial information you give us in order to clearly reflect your Work Earnings.

If we determine that your earnings vary substantially from month to month, we may determine your Work Earnings by averaging your earnings over the most recent three-month period. LTD Benefits will end on the date your average Work Earnings over the last three months equal or exceed 80% of your Indexed Predisability Earnings.

B. Family Care Expenses Adjustment
If you must pay Family Care Expenses in order to work, we will reduce the amount of the Work Earnings used in determining your Deductible Income, subject to the following:

1. Your Work Earnings will be reduced by the first $250 per Family Member of the monthly Family Care Expenses you pay, but not to exceed a total of $500 for all Family Members.

2. The Work Earnings and the Family Care Expenses must be for the same period.

3. You must give us satisfactory proof of the Family Care Expenses you pay.

4. The Work Earnings reduction by Family Care Expenses will end 12 months after it begins.

Family Care Expenses means the amount you pay to a licensed care provider for the care of your Family which is necessary in order for you to work.

Family Member means:

1. Your Child; or

2. Your Spouse, parent, grandparent, sibling, or other close family member residing in your home who is:
a. Continuously incapable of self-sustaining employment because of mental retardation or physical handicap; and
b. Chiefly dependent upon you for support and maintenance.

Child means:
9/2026 - 8 - 764999

1. Your child residing in your home (including your stepchild, the child of your Spouse and an adopted child), from live birth through age 13; or

2. Your child, age 14 or older, residing in your home (including your stepchild, the child of your Spouse and an adopted child) who is:
a. Continuously incapable of self-sustaining employment because of mental retardation or physical handicap; and
b. Chiefly dependent upon you for support and maintenance. (NO RESP_FAMILY CR_DOMP) LT.RW.CA.1

REASONABLE ACCOMMODATION EXPENSE BENEFIT
If you return to work in any occupation for any employer, not including self-employment, as a result of a reasonable accommodation made by such employer, we will pay that employer a Reasonable Accommodation Expense Benefit of up to $25,000, but not to exceed the expenses incurred.

The Reasonable Accommodation Expense Benefit is payable only if the reasonable accommodation is approved by us in writing prior to its implementation.

LT.RA.OT.1

REHABILITATION PLAN PROVISION
While you are Disabled you may qualify to participate in a Rehabilitation Plan. Rehabilitation Plan means a written plan, program or course of vocational training or education that is intended to prepare you to return to work.

To participate in a Rehabilitation Plan you must apply on our forms or in a letter to us. The terms, conditions and objectives of the plan must be accepted by you and approved by us in advance. We have the sole discretion to approve your Rehabilitation Plan.

While you are participating in an approved Rehabilitation Plan, your LTD Benefit will be increased by 10% of your Predisability Earnings. Your LTD Benefit may not exceed the Maximum LTD Benefit shown in the Coverage Features as a result of this increase.

An approved Rehabilitation Plan may include our payment of some or all of the expenses you incur in connection with the plan, including:
a. Training and education expenses.
b. Family care expenses.
c. Job-related expenses.
d. Job search expenses.
(WITH REHAB INC BFT) LT.RH.OT.1

TEMPORARY RECOVERY
You may temporarily recover from your Disability and then become Disabled again from the same cause or causes without having to serve a new Benefit Waiting Period. Temporary Recovery means you cease to be Disabled for no longer than the applicable Allowable Period. See Definition Of Disability.

A. Allowable Periods

1. During the Benefit Waiting Period: a total of 90 days of recovery.

2. During the Maximum Benefit Period: 180 days for each period of recovery.

B. Effect Of Temporary Recovery
9/2026 - 9 - 764999
If your Temporary Recovery does not exceed the Allowable Periods, the following will apply.

1. The Predisability Earnings used to determine your LTD Benefit will not change.

2. The period of Temporary Recovery will not count toward your Benefit Waiting Period, your Maximum Benefit Period or your Own Occupation Period.

3. No LTD Benefits will be payable for the period of Temporary Recovery.

4. No LTD Benefits will be payable after benefits become payable to you under any other disability insurance plan under which you become insured during your period of Temporary Recovery.

5. Except as stated above, the provisions of the Group Policy will be applied as if there had been no interruption of your Disability.
(NEW TR PERIOD) LT.TR.OT.1

WHEN LTD BENEFITS END
Your LTD Benefits end automatically on the earliest of:

1. The date you are no longer Disabled.

2. The date your Maximum Benefit Period ends.

3. The date you die.

4. The date benefits become payable under any other LTD plan under which you become insured through employment during a period of Temporary Recovery.

5. The date you fail to provide proof of continued Disability and entitlement to LTD Benefits.

6. The date your Work Earnings equal or exceed 80% of your Indexed Predisability Earnings.

LT.BE.CA.1

PREDISABILITY EARNINGS
Your Predisability Earnings will be based on your earnings in effect on your last full day of Active Work. Any subsequent change in your earnings after that last full day of Active Work will not affect your Predisability Earnings.

Predisability Earnings means your monthly rate of earnings from your Employer, including:

1. Contributions you make through a salary reduction agreement with your Employer to:
a. An Internal Revenue Code (IRC) Section 401(k), 403(b), 408(k), 408(p), or 457 deferred compensation arrangement; or
b. An executive nonqualified deferred compensation arrangement.

2. Shift differential pay.

3. Amounts contributed to your fringe benefits according to a salary reduction agreement under an IRC Section 125 plan.

Predisability Earnings does not include:

1. Bonuses.

2. Commissions.

3. Overtime pay.

4. Stock options or stock bonuses.

5. Your Employer's contributions on your behalf to any deferred compensation arrangement or pension plan. 9/2026 - 10 - 764999

6. Any other extra compensation.

If you are paid on an annual contract basis, your monthly rate of earnings is one-twelfth (1/12th) of your annual contract salary.

If you are paid hourly, your monthly rate of earnings is based on your hourly pay rate multiplied by the number of hours you are regularly scheduled to work per month, but not more than 173 hours. If you do not have regular work hours, your monthly rate of earnings is based on the average number of hours you worked per month during the preceding 12 calendar months (or during your period of employment if less than 12 months), but not more than 173 hours. (REG NO COM_NO STOCK) LT.PD.OT.1

DEDUCTIBLE INCOME
Subject to Exceptions To Deductible Income, Deductible Income means:

1. Sick pay, annual or personal leave pay, severance pay, or other salary continuation, including donated amounts, (but not vacation pay) paid to you by your Employer.

2. Your Work Earnings, as described in the Return To Work Provisions.

3. Any amount you receive or are entitled to receive because of your disability, including amounts for partial or total disability, whether permanent, temporary, or vocational, under any of the following:
a. A workers' compensation law;
b. The Jones Act;
c. Maritime Doctrine of Maintenance, Wages, or Cure;
d. Longshoremen's and Harbor Worker's Act; or
e. Any similar act or law.

4. Any amount you, your Spouse, or your child under age 18 receive or are entitled to receive because of your Disability or you receive because of your retirement under:
a. The Federal Social Security Act;
b. The Canada Pension Plan;
c. The Quebec Pension Plan;
d. The Railroad Retirement Act; or
e. Any similar plan or act.

Amounts that are entitled to be received will be deducted in accordance with the Estimating and Deducting section of Rules For Deductible Income.

Full offset: Both the primary benefit (the benefit awarded to you) and dependents benefit are Deductible Income.

Benefits your Spouse or a child receives or are entitled to receive because of your Disability are Deductible Income regardless of marital status, custody, or place of residence. The term "child" has the meaning given in the applicable plan or act.

5. Any amount you receive or are entitled to receive because of your disability under any state disability income benefit law or similar law.

6. Any amount you receive because of your disability under any other group insurance coverage, as determined below:
a. Determine the amount of your LTD Benefit as if there were no Deductible Income, add the amount you receive from any other insurance coverage because of your Disability. b. Determine 80% of your Indexed Predisability Earnings. 9/2026 - 11 - 764999
c. If a. is greater than b., the difference will be Deductible Income.

7. Any disability or retirement benefits you receive under your Employer's retirement plan.

Your and your Employer's contributions will be considered as distributed simultaneously throughout your lifetime, regardless of how funds are distributed from the retirement plan.

8. Any earnings or compensation included in Predisability Earnings which you receive or have a right to receive while LTD Benefits are payable.

9. Any amount you receive under any unemployment compensation law or similar act or law.

10. Any amount of third party liability payments you receive by judgment, settlement or otherwise (less attorneys' fees).

11. Any amount you receive by compromise, settlement, or other method as a result of a claim for any of the above, whether disputed or undisputed.
(SL CHOICE_CA DOM_GRP OTHR OFFST_PRIV_WITH 3RD) LT.DI.CA.1

EXCEPTIONS TO DEDUCTIBLE INCOME
Deductible Income does not include:

1. Any cost of living increase in any Deductible Income other than Work Earnings, if the increase becomes effective while you are Disabled and while you are eligible for the Deductible Income.

2. Reimbursement for hospital, medical, or surgical expense.

3. Reasonable attorneys fees incurred in connection with a claim for Deductible Income.

4. Benefits from any individual disability insurance policy.

5. Early retirement benefits under the Federal Social Security Act which are not actually received.

6. Group credit or mortgage disability insurance benefits.

7. Accelerated death benefits paid under a life insurance policy.

8. Benefits from the following:
a. Profit sharing plan.
b. Thrift or savings plan.
c. Deferred compensation plan.
d. Plan under IRC Section 401(k), 408(k), 408(p), or 457. e. Individual Retirement Account (IRA).
f. Tax Sheltered Annuity (TSA) under IRC Section 403(b). g. Stock ownership plan.
h. Keogh (HR-10) plan.

9. The following amounts under your Employer's retirement plan:
a. A lump sum distribution of your entire interest in the plan. b. Any amount which is attributable to your contributions to the plan. c. Any amount you could have received upon termination of employment without being disabled or retired.

10. California Workers' Compensation benefits for permanent total or permanent partial disability. (PRIV_WITH OTHR OFFST) LT.ED.CA.1
9/2026 - 12 - 764999

RULES FOR DEDUCTIBLE INCOME
A. Monthly Equivalents
Each month we will determine your LTD Benefit using the Deductible Income for the same monthly period, even if you actually receive the Deductible Income in another month.

If you are paid Deductible Income in a lump sum or by a method other than monthly, we will determine your LTD Benefit using a prorated amount. Except as provided below, we will use the period of time to which the Deductible Income applies. If no period of time is stated, we will use a reasonable one.

If you receive a lump sum refund, withdrawal or distribution of contributions and earnings from your Employer's retirement plan, we will determine your LTD Benefit using a lifetime monthly annuity amount, with no survivor income. The annuity will be based on the amount you receive, and on the life expectancy of a person your age on the later of:
a. The date the lump sum is paid; and
b. The date LTD Benefits become payable.

For amounts under a workers’ compensation law, the Jones Act, the Maritime Doctrine of Maintenance, Wages or Cure, the Longshoremen’s and Harbor Worker’s Act, or any similar act or law, the period of time used to prorate the amount cannot exceed the first to occur of the following:
a. The date you reach age 65, or the end of the Maximum Benefit Period, if later; and b. The end of the stated period.

B. Your Duty To Pursue Deductible Income
You must pursue Deductible Income for which you may be entitled. We may ask for written documentation of your pursuit of Deductible Income. You must provide it within 60 days after we mail you our request.

C. Estimating And Deducting
For any item of Deductible Income that includes amounts you, your Spouse, or your child are entitled to receive, we may reduce your LTD Benefit by the amount we estimate you would be entitled to receive if:

1. You have failed to pursue the Deductible Income with reasonable diligence;

2. We have a reasonable, good faith belief that you are entitled to the Deductible Income; and

3. We are able to reasonably estimate the amount that would be payable.

We will not estimate and deduct amounts with respect to a claim for Deductible Income that is pending, so long as you continue to pursue the claim with reasonable diligence.

D. Retirement Benefits

1. Early retirement benefits will be Deductible Income only if you elect early retirement, or if early retirement would not reduce your accrued annuity or pension benefits.

2. Retirement benefits received will not include amounts rolled over or transferred to any eligible retirement plan as defined in the Internal Revenue Code.

E. Pending Deductible Income
We will not deduct pending Deductible Income until it becomes payable. You must notify us of the amount of the Deductible Income when it is approved. You must repay us for the resulting overpayment of your claim.

F. Overpayment Of Claim
We will notify you of the amount of any overpayment of your claim under any group disability insurance policy issued by us. You must immediately repay us. You will not receive any LTD Benefits until we have been repaid in full. In the meantime, any LTD Benefits paid, including the Minimum LTD Benefit, will be applied to reduce the 9/2026 - 13 - 764999
amount of the overpayment. We may charge you interest at the legal rate for any overpayment which is not repaid within 30 days after we first mail you notice of the amount of the overpayment.

LT.RU.CA.1

SURVIVORS BENEFIT
If you die while LTD Benefits are payable, and on the date you die you have been continuously Disabled for at least 180 days, we will pay a Survivors Benefit according to 1 through 4 below.

1. The Survivors Benefit is a lump sum equal to 3 times your LTD Benefit without reduction by Deductible Income.

2. The Survivors Benefit will first be applied to reduce any overpayment of your claim.

3. The Survivors Benefit will be paid to any one or more of the following:
a. Your surviving Spouse;
b. Your surviving unmarried children, including adopted children, under age 25; c. Your surviving Spouse's unmarried children, including adopted children, under age 25; or d. Any person providing the care and support of any person listed in a., b., or c. above.

4. No Survivors Benefit will be paid if you are not survived by any person listed in a., b., or c. above. (MULTPL_DOM) LT.SB.CA.1

BENEFITS AFTER INSURANCE ENDS OR IS CHANGED
During each period of continuous Disability, we will pay LTD Benefits according to the terms of the Group Policy in effect on the date you become Disabled. Your right to receive LTD Benefits will not be affected by:

1. Any amendment to the Group Policy that is effective after you become Disabled.

2. Termination of the Group Policy after you become Disabled.

LT.BA.OT.1

EFFECT OF NEW DISABILITY
If a period of Disability is extended by a new cause while LTD Benefits are payable, LTD Benefits will continue while you remain Disabled. However, 1 and 2 apply.

1. LTD Benefits will not continue beyond the end of the original Maximum Benefit Period.

2. The Disabilities Excluded From Coverage and Limitations sections will apply to the new cause of Disability.

LT.ND.CA.1

DISABILITIES EXCLUDED FROM COVERAGE
A. War
You are not covered for a Disability caused or contributed to by War or any act of War. War means declared or undeclared war, whether civil or international, and any substantial armed conflict between organized forces of a military nature.

B. Intentionally Self-Inflicted Injury
You are not covered for a Disability caused or contributed to by an intentionally self-inflicted Injury, while sane or insane.

C. Preexisting Condition
9/2026 - 14 - 764999

1. Definition
Preexisting Condition means:
a. A diagnosed mental or physical condition for which you have received medical treatment, care or services or have taken prescribed medication at any time during the 90 day period just before your insurance becomes effective; or
b. A mental or physical condition, whether diagnosed or undiagnosed, (i) For which you have received medical treatment, care or services or have taken prescribed medication at any time during the 90 day period just before your insurance becomes effective, or (ii) Which caused symptoms at any time during the 90 day period just before your insurance becomes effective for which a prudent person would usually seek medical treatment, care or services, and which was misrepresented or not disclosed in your application or medical history statement.

2. Exclusion
You are not covered for a Disability caused or substantially contributed to by a Preexisting Condition or medical or surgical treatment of a Preexisting Condition unless, on the date you become Disabled, you:
a. Have been continuously insured under the Group Policy for 12 months; and b. Have been Actively At Work for at least one full day after the end of that 12 months.

D. Criminal Conduct
You are not covered for a Disability caused or contributed to by your committing or attempting to commit a felony. (WITH PRUDNT) LT.XD.CA.1

LIMITATIONS
A. Care Of A Physician
During the Benefit Waiting Period, you must be receiving care by a Physician which is appropriate for the condition or conditions causing the Disability. No LTD Benefits will be paid for any period of Disability when you are not receiving care by a Physician which is appropriate for the condition or conditions causing the Disability.

Appropriate care is the treatment a patient would make a reasonable decision to accept after duly considering the opinions of medical professionals. This limitation will not apply after you reach your maximum point of recovery.

B. Rehabilitation Program
No LTD Benefits will be paid for any period of Disability when you are not participating in good faith in a plan, program or course of medical treatment or vocational training or education approved by us unless your Disability prevents you from participating.

C. Foreign Residency
Payment of LTD Benefits is limited to 12 months for each period of continuous Disability while you reside outside of the United States or Canada.

D. Imprisonment
No LTD Benefits will be paid for any period of Disability when you are confined for any reason in a penal or correctional institution.

E. Mental Disorder
Payment of LTD Benefits is limited to 24 months during your entire lifetime for a Disability caused or contributed to by a Mental Disorder. However, if you are confined in a Hospital at the end of the Mental Disorder Limitation Period, this limitation will not apply while you are continuously confined. 9/2026 - 15 - 764999
Mental Disorder means any mental, emotional, behavioral, psychological, personality, cognitive, mood or stressrelated abnormality, disorder, disturbance, dysfunction or syndrome, regardless of cause, (including any biological or biochemical disorder or imbalance of the brain) or the presence of physical symptoms. Mental Disorder includes, but is not limited to, bipolar affective disorder, organic brain syndrome, schizophrenia, psychotic illness, manic depressive illness, depression and depressive disorders, or anxiety and anxiety disorders.

Hospital means a legally operated hospital providing full-time medical care and treatment under the direction of a full-time staff of licensed Physicians. Rest homes, nursing homes, convalescent homes, homes for the aged, and facilities primarily affording custodial, educational, or rehabilitative care are not Hospitals.

F. Alcohol Use, Alcoholism Or Drug Use
Payment of LTD Benefits is limited to 24 months during your entire lifetime for a Disability caused or contributed to by your use of alcohol, alcoholism, use of any drug, including hallucinogens, or drug addiction.

G. Musculoskeletal And Connective Tissue Disorder
Payment of LTD Benefits is limited to 24 months during your entire lifetime for a Disability caused or contributed to by musculoskeletal or connective tissue disorders including, but not limited to:

1. Any disease or disorder of the cervical, thoracic, or lumbosacral back and its surrounding soft tissue.

2. Sprains or strains of joints or muscles.

3. Carpal tunnel or repetitive motion syndrome.

4. Fibromyalgia.

5. Temporomandibular joint or craniomandibular joint disorder.

6. Myofascial pain.

7. Arthritis.

This limitation will not apply to:
a. Herniated discs with neurological abnormalities that are documented by electromyogram, and computerized tomography or magnetic resonance imaging.
b. Scoliosis.
c. Tumors, malignancies, or vascular malformations.
d. Radiculopathies that are documented by electromyogram. e. Spondylolisthesis, grade II or higher.
f. Myelopathies and myelitis.
g. Demyelinating diseases.
h. Traumatic spinal cord necrosis.
i. Osteopathies.
j. Rheumatoid or psoriatic arthritis.
k. Lupus.

H. Chronic Fatigue Conditions
Payment of LTD Benefits is limited to 24 months during your entire lifetime for a Disability caused or contributed to by chronic fatigue conditions including, but not limited to:

1. Chronic Fatigue Syndrome.

2. Chronic Fatigue Immunodeficiency Syndrome.
9/2026 - 16 - 764999

3. Post Viral Syndrome.

4. Limbic Encephalopathy.

5. Epstein-Barr virus infection.

6. Herpesvirus type 6 infection.

7. Myalgic Encephalomyelitis.

This limitation will not apply to clinical conditions where a cause for the chronic fatigue is otherwise identifiable, such as:
a. Neoplastic disorders.
b. Neurological disorders.
c. Endocrine disorders.
d. Hematological disorders.
e. Rheumatologic disorders.
f. Depression.

I. Chemical And Environmental Sensitivities
Payment of LTD Benefits is limited to 24 months during your entire lifetime for a Disability caused or contributed to by an allergy or sensitivity to chemicals or the environment including, but not limited to:

1. Environmental allergies.

2. Sick Building Syndrome.

3. Multiple Chemical Sensitivity Syndrome.

4. Chronic Toxic Encephalopathy.

This limitation will not apply to:
a. Asthma.
b. Allergy-induced reactive lung disease.

J. Rules For Disabilities Subject To Limited Pay Periods

1. If you are Disabled as a result of more than one Physical Disease, Injury or Mental Disorder for which LTD Benefits are payable for a limited period of time, the limitation periods will run concurrently for all limited conditions.

2. If you are Disabled as a result of a Mental Disorder or any Physical Disease or Injury for which LTD Benefits are payable for a limited period of time, and at the same time are Disabled as a result of a Physical Disease, Injury or Pregnancy that is not subject to such limitation, LTD Benefits will be payable first for conditions that are subject to a limitation before LTD Benefits are payable for any condition that is not subject to a limitation.

3. No LTD Benefits will be payable after the ending date of the longest limitation period that applies to your Disability, unless on that date you continue to be Disabled as a result of a Physical Disease, Injury or Pregnancy for which payment of LTD Benefits is not limited.
(SBST_MAND REHB_MUSC_CHRON_ENVIR_PRIS_FOR RES) LT.LM.CA.1 CLAIMS
A. Notice Of Claim
9/2026 - 17 - 764999
Written notice of claim must be provided to us within 60 days after the date you claim you became Disabled, or as soon thereafter as is reasonably possible.

B. Filing A Claim
Claims should be filed on our forms. If we do not provide our forms within 15 days after they are requested, you may submit your claim in a letter to us. The letter should include the date disability began, and the cause and nature of the disability. Subject to the time period for providing notice of claim, such letter will constitute notice and proof of claim.

C. Time Limits On Filing Proof Of Loss
You must give us Proof Of Loss within 90 days after the end of the Benefit Waiting Period. If your claim was closed, you must give us Proof Of Loss within 90 days after the date LTD Benefits ended. If you cannot do so, you must give it to us as soon as reasonably possible, but not later than one year after that 90-day period. If Proof Of Loss is filed outside these time limits, your claim will be denied. These limits will not apply while you lack legal capacity.

D. Proof Of Loss
Proof Of Loss means written proof that you are Disabled and entitled to LTD Benefits. Proof Of Loss must be provided at your expense.

For claims of Disability due to conditions other than Mental Disorders, we may require proof of physical impairment that results from anatomical or physiological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques. Examples of clinical and laboratory diagnostic techniques include but are not limited to actual observations upon physical examinations, blood tests, imaging studies (such as x-rays, MRIs and CT scans), electrocardiograms (EKG) and electroencephalograms (EEG).

E. Documentation
Completed claims statements, a signed authorization for us to obtain information, and any other items we may reasonably require in support of a claim must be submitted at your expense. If the required documentation is not provided within 45 days after we mail our request, your claim may be denied.

F. Investigation Of Claim
We may investigate your claim at any time.

At our expense, we may have you examined at reasonable intervals by specialists of our choice. We may deny or suspend LTD Benefits if you fail to attend an examination or cooperate with the examiner.

G. Time Of Payment
We will pay LTD Benefits within 60 days after you satisfy Proof Of Loss.

LTD Benefits will be paid to you at the end of each month you qualify for them. LTD Benefits remaining unpaid at your death will be paid to the person(s) receiving the Survivors Benefit. If no Survivors Benefit is paid, the unpaid LTD Benefits will be paid to your estate.

H. Notice Of Decision On Claim
We will evaluate your claim promptly after you file it. Within 45 days after we receive your claim we will send you:
(a) a written decision on your claim; or (b) a notice that we are extending the period to decide your claim for 30 days. Before the end of this extension period we will send you: (a) a written decision on your claim; or (b) a notice that we are extending the period to decide your claim for an additional 30 days. If an extension is due to your failure to provide information necessary to decide the claim, the extended time period for deciding your claim will not begin until you provide the information or otherwise respond.

If we extend the period to decide your claim, we will notify you of the following: (a) the reasons for the extension; (b) when we expect to decide your claim; (c) an explanation of the standards on which entitlement to benefits is based; (d) the unresolved issues preventing a decision; and (e) any additional information we need to resolve those issues.
9/2026 - 18 - 764999
If we request additional information, you will have 45 days to provide the information. If you do not provide the requested information within 45 days, we may decide your claim based on the information we have received.

If we deny any part of your claim, you will receive a written notice of denial containing:
a. The reasons for our decision.
b. Reference to the parts of the Group Policy on which our decision is based. c. Reference to any internal rule or guideline relied upon in making our decision. d. A description of any additional information needed to support your claim. e. Information concerning your right to a review of our decision. f. Information concerning your right to bring a civil action for benefits under section 502(a) of ERISA if your claim is denied on review.

I. Review Procedure
If all or part of a claim is denied, you may request a review. You must request a review in writing within 180 days after receiving notice of the denial.

You may send us written comments or other items to support your claim. You may review and receive copies of any non-privileged information that is relevant to your request for review. There will be no charge for such copies.

You may request the names of medical or vocational experts who provided advice to us about your claim.

The person conducting the review will be someone other than the person who denied the claim and will not be subordinate to that person. The person conducting the review will not give deference to the initial denial decision.

If the denial was based on a medical judgment, the person conducting the review will consult with a qualified health care professional. This health care professional will be someone other than the person who made the original medical judgment and will not be subordinate to that person. Our review will include any written comments or other items you submit to support your claim.

We will review your claim promptly after we receive your request. Within 45 days after we receive your request for review we will send you: (a) a written decision on review; or (b) a notice that we are extending the review period for 45 days. If the extension is due to your failure to provide information necessary to decide the claim on review, the extended time period for review of your claim will not begin until you provide the information or otherwise respond.

If we extend the review period, we will notify you of the following: (a) the reasons for the extension; (b) when we expect to decide your claim on review; and (c) any additional information we need to decide your claim.

If we request additional information, you will have 45 days to provide the information. If you do not provide the requested information within 45 days, we may conclude our review of your claim based on the information we have received.

If we deny any part of your claim on review, you will receive a written notice of denial containing:
a. The reasons for our decision.
b. Reference to the parts of the Group Policy on which our decision is based. c. Reference to any internal rule or guideline relied upon in making our decision. d. Information concerning your right to receive, free of charge, copies of non-privileged documents and records relevant to your claim.
e. Information concerning your right to bring a civil action for benefits under section 502(a) of ERISA.

The Group Policy does not provide voluntary alternative dispute resolution options. However, you may contact your local U.S. Department of Labor Office and your State insurance regulatory agency for assistance.

J. Assignment
9/2026 - 19 - 764999
The rights and benefits under the Group Policy are not assignable. (REV PRIV WRDG) LT.CL.CA.1

TIME LIMITS ON LEGAL ACTIONS
No action at law or in equity may be brought until 60 days after you have given us Proof Of Loss. No such action shall be brought after the expiration of three years after the date Proof Of Loss is required to be given.

LT.TL.CA.1

INCONTESTABILITY PROVISIONS
A. Incontestability Of Insurance
Any statement made to obtain insurance or to increase insurance is a representation and not a warranty.

No misrepresentation will be used to reduce or deny a claim or contest the validity of insurance unless:

1. The insurance would not have been approved if we had known the truth; and

2. We have given you or any other person claiming benefits a copy of the signed written instrument which contains the misrepresentation.

After insurance has been in effect for two years, during the lifetime of the insured, we will not use a misrepresentation by you to reduce or deny your claim, unless it was a fraudulent misrepresentation.

B. Incontestability Of The Group Policy
Any statement made by the Policyholder or Employer to obtain the Group Policy is a representation and not a warranty.

No misrepresentation by the Policyholder or your Employer will be used to deny a claim or to deny the validity of the Group Policy unless:

1. The Group Policy would not have been issued if we had known the truth; and

2. We have given the Policyholder or Employer a copy of a written instrument signed by the Policyholder or Employer which contains the misrepresentation.

The validity of the Group Policy will not be contested after it has been in force for two years, except for fraudulent misrepresentations.

LT.IN.CA.1

CLERICAL ERROR, AGENCY, AND MISSTATEMENT
A. Clerical Error
Clerical error by the Policyholder, your Employer, or their respective employees or representatives will not:

1. Cause a person to become insured.

2. Invalidate insurance under the Group Policy otherwise validly in force.

3. Continue insurance under the Group Policy otherwise validly terminated.

B. Agency
The Policyholder and your Employer act on their own behalf as your agent, and not as our agent. The Policyholder and your Employer have no authority to alter, expand or extend our liability or to waive, modify or compromise any defense or right we may have under the Group Policy.

C. Misstatement Of Age
9/2026 - 20 - 764999
If a person's age has been misstated, we will make an equitable adjustment of premiums, benefits, or both. The adjustment will be based on:

1. The amount of insurance based on the correct age; and

2. The difference between the premiums paid and the premiums which would have been paid if the age had been correctly stated.

LT.CE.OT.1

TERMINATION OR AMENDMENT OF THE GROUP POLICY
The Group Policy may be terminated by us or the Policyholder according to its terms. It will terminate automatically for nonpayment of premium. The Policyholder may terminate the Group Policy in whole, and may terminate insurance for any class or group of Members, at any time by giving us written notice.

Benefits under the Group Policy are limited to its terms, including any valid amendment. No change or amendment will be valid unless it is approved in writing by one of our executive officers and given to the Policyholder for attachment to the Group Policy. If the terms of the certificate differ from the Group Policy, the terms stated in the Group Policy will govern. The Policyholder, your Employer, and their respective employees or representatives have no right or authority to change or amend the Group Policy or to waive any of its terms or provisions without our signed written approval.

We may change the Group Policy in whole or in part when any change or clarification in law or governmental regulation affects our obligations under the Group Policy, or with the Policyholder's consent.

Any such change or amendment of the Group Policy may apply to current or future Members or to any separate classes or groups of Members.

LT.TA.OT.1

DEFINITIONS
Benefit Waiting Period means the period you must be continuously Disabled before LTD Benefits become payable. No LTD Benefits are payable for the Benefit Waiting Period. See Coverage Features.

Contributory means insurance is elective and Members pay all or part of the premium for insurance.

CPI-W means the Consumer Price Index for Urban Wage Earners and Clerical Workers published by the United States Department of Labor. If the CPI-W is discontinued or changed, we may use a comparable index. Where required, we will obtain prior state approval of the new index.

Eligibility Waiting Period means the period you must be a Member before you become eligible for insurance. Your Eligibility Waiting Period is shown in the Coverage Features.

Employer means an employer (including approved affiliates and subsidiaries) for which coverage under the Group Policy is approved in writing by us.

Providing Evidence Of Insurability means you must:

1. Complete and sign our medical history statement;

2. Sign our form authorizing us to obtain information about your health;

3. Undergo a physical examination, if required by us, which may include blood testing; and

4. Provide any additional information about your insurability that we may reasonably require.

Group Policy means the group LTD insurance policy issued by us to the Policyholder and identified by the Group Policy Number.

Indexed Predisability Earnings means your Predisability Earnings adjusted by the rate of increase in the CPI-W. During your first year of Disability, your Indexed Predisability Earnings are the same as your Predisability Earnings. Thereafter, your Indexed Predisability Earnings are determined on each anniversary of your Disability by increasing the previous 9/2026 - 21 - 764999
year's Indexed Predisability Earnings by the rate of increase in the CPI-W for the prior calendar year. The maximum adjustment in any year is 10%. Your Indexed Predisability Earnings will not decrease, even if the CPI-W decreases.

Injury means an injury to the body.

L.L.C. Owner-Employee means an individual who owns an equity interest in an Employer and is actively employed in the conduct of the Employer's business.

LTD Benefit means the monthly benefit payable to you under the terms of the Group Policy.

Maximum Benefit Period means the longest period for which LTD Benefits are payable for any one period of continuous Disability, whether from one or more causes. It begins at the end of the Benefit Waiting Period. No LTD Benefits are payable after the end of the Maximum Benefit Period, even if you are still Disabled. See Coverage Features.

Noncontributory means (a) insurance is nonelective and the Policyholder or Employer pay the entire premium for insurance; or (b) the Policyholder or Employer require all eligible Members to have insurance and to pay all or part of the premium for insurance.

P.C. Partner means the sole active employee and majority shareholder of a professional corporation in partnership with the Policyholder.

Physical Disease means a physical disease entity or process that produces structural or functional changes in the body as diagnosed by a Physician.

Physician means a licensed medical professional, diagnosing and treating individuals within the scope of the license.

The term includes a legally licensed physician, dentist, optometrist, podiatrist, psychologist or chiropractor. Physician does not include you or your Spouse, or the brother, sister, parent or child of either you or your Spouse.

Pregnancy means your pregnancy, childbirth, or related medical conditions, including complications of pregnancy.

Prior Plan means your Employer's group long term disability insurance plan in effect on the day before the effective date of your Employer's participation under the Group Policy and which is replaced by coverage under the Group Policy.

Spouse means:

1. A person to whom you are legally married; or

2. Your Domestic Partner. Your Domestic Partner means an individual recognized as such under California state law.
(DOM STAT) LT.DF.CA.1

POLICYHOLDER PROVISIONS
A. Premiums
The premium due on each Premium Due Date is the sum of the premiums for all persons then insured. Premium Rates are shown in the Coverage Features.

B. Contributions From Members
The Policyholder determines the amount, if any, of each Member's contribution toward the cost of insurance under the LTD Group Policy.

C. Changes In Premium Rates
We may change Premium Rates whenever:

1. A change or clarification in law or governmental regulation affects the amount payable under the Group Policy.

Any such change in Premium Rates will reflect only the change in our obligations.

2. Factors material to underwriting the risk we assumed under the Group Policy with respect to an Employer, including, but not limited to, number of persons insured, age, Predisability Earnings, gender, and occupational classification, changes by 25% or more.
9/2026 - 22 - 764999

3. The premium contribution arrangement for Members is changed or varies from that stated in the Group Policy when issued or last renewed.

4. We and the Policyholder or the Employer mutually agree to change Premium Rates.

Except as provided above, Premium Rates will not be changed during the Initial Rate Guarantee Period shown in the Coverage Features. Thereafter, except as provided above, we may change Premium Rates upon 180 days advance written notice to the Policyholder. Any such change in Premium Rates may be made effective on any Premium Due Date, but no such change will be made more than once in any contract year. Contract years are successive 12 month periods computed from the end of the Initial Rate Guarantee Period.

D. Payment Of Premiums
All premiums are due on the Premium Due Dates shown in the Coverage Features.

Each premium is payable on or before its Premium Due Date directly to us at our home office. The payment of each premium by the Policyholder as it becomes due will maintain the Group Policy in force until the next Premium Due Date.

E. Grace Period And Termination For Nonpayment
If a premium is not paid on or before its Premium Due Date, it may be paid during the following Grace Period of 60 days. The Group Policy or an Employer's coverage under the Group Policy will remain in force during the Grace Period.

If the premium is not paid during the Grace Period, the Group Policy will terminate automatically at the end of the Grace Period.

The Policyholder is liable for premium for coverage during the Grace Period. We may charge interest at the legal rate for any premium which is not paid during the Grace Period, beginning with the first day after the Grace Period.

F. Termination For Other Reasons
The Policyholder may terminate the Group Policy by giving us written notice. The effective date of termination will be the later of:

1. The date stated in the notice; and

2. The date we receive the notice.

We may terminate the Group Policy as follows:

1. On any Premium Due Date if the number of persons insured is less than the Minimum Participation shown in the Coverage Features.

2. On any Premium Due Date if we determine that the Policyholder has failed to promptly furnish any necessary information requested by us, or has failed to perform any other obligations relating to the Group Policy.

The minimum advance notice of termination by us is 180 days.

G. Premium Adjustments
Premium adjustments involving a return of unearned premiums to the Policyholder will be limited to the 12 months just before the date we receive a request for premium adjustment.

H. Certificates
We will issue certificates to the Policyholder showing the coverage under the Group Policy. The Policyholder will distribute a certificate to each insured Member. If the terms of the certificate differ from the Group Policy, the terms stated in the Group Policy will govern.

I. Records And Reports
9/2026 - 23 - 764999
The Policyholder will furnish on our forms all information reasonably necessary to administer the Group Policy.

We have the right at all reasonable times to inspect the payroll and other records of the Policyholder which relate to insurance under the Group Policy.

J. Agency And Release
Individuals selected by the Policyholder or by any Employer to secure coverage under the Group Policy or to perform their administrative function under it, represent and act on behalf of the person selecting them, and do not represent or act on behalf of Standard. The Policyholder, Employer and such individuals have no authority to alter, expand or extend our liability or to waive, modify or compromise any defense or right we may have under the Group Policy. The Policyholder and each Employer hereby release, hold harmless and indemnify Standard from any liability arising from or related to any negligence, error, omission, misrepresentation or dishonesty of any of them or their representatives, agents or employees.

K. Notice Of Suit
The Policyholder or Employer shall promptly give us written notice of any lawsuit or other legal proceedings arising under the Group Policy.

L. Entire Contract, Changes
The Group Policy and the applications of the Policyholder constitute the entire contract between the parties. A copy of the Policyholder's application is attached to the Group Policy when issued.

The Group Policy may be changed in whole or in part. No change in the Group Policy will be valid unless it is approved in writing by one of our executive officers and given to the Policyholder for attachment to the Group Policy. No agent has authority to change the Group Policy, or to waive any of its provisions.

M. Effect On Workers' Compensation, State Disability Insurance The coverage provided under the Group Policy is not a substitute for coverage under a workers' compensation or state disability income benefit law and does not relieve the Employer of any obligation to provide such coverage. (NO DIV) LT.PH.OT.1
CA/LTDP2000(CA09)

NOTICE OF PROTECTION PROVIDED BY CALIFORNIA LIFE AND HEALTH

INSURANCE GUARANTEE ASSOCIATION
This notice provides a brief summary regarding the protections provided to policyholders by the California Life and Health Insurance Guarantee Association ("the Association").

The purpose of the Association is to assure that policyholders will be protected, within certain limits, in the unlikely event that a member insurer of the Association becomes financially unable to meet its obligations. Insurance companies licensed in California to sell life insurance, health insurance, annuities and structured settlement annuities are members of the Association. The protection provided by the Association is not unlimited and is not a substitute for consumers’ care in selecting insurers. This protection was created under California law, which determines who and what is covered and the amounts of coverage.

Below is a brief summary of the coverages, exclusions and limits provided by the Association. This summary does not cover all provisions of the law; nor does it in any way change anyone’s rights or obligations or the rights or obligations of the Association.

COVERAGE
 Persons Covered
Generally, an individual is covered by the Association if the insurer was a member of the Association and the individual lives in California at the time the insurer is determined by a court to be insolvent. Coverage is also provided to policy beneficiaries, payees or assignees, whether or not they live in California  Amounts of Coverage
The basic coverage protections provided by the Association are as follows.  Life Insurance, Annuities and Structured Settlement Annuities For life insurance policies, annuities and structured settlement annuities, the Association will provide the following:
 Life Insurance
80% of death benefits but not to exceed $300,000
80% of cash surrender or withdrawal values but not to exceed $100,000  Annuities and Structured Settlement Annuities
80% of the present value of annuity benefits, including net cash withdrawal and net cash surrender values but not to exceed $250,000 The maximum amount of protection provided by the Association to an individual, for all life insurance, annuities and structured settlement annuities is $300,000, regardless of the number of policies or contracts covering the individual.
 Health Insurance
The maximum amount of protection provided by the Association to an individual, as of July 1, 2016, is $546,741. This amount will increase or decrease based upon changes in the health care cost component of the consumer price index to the date on which an insurer becomes an insolvent insurer. Changes to this amount will be posted on the Association’s website www.califega.org.

COVERAGE LIMITATIONS AND EXCLUSIONS FROM COVERAGE
The Association may not provide coverage for this policy. Coverage by the Association generally requires residency in California. You should not rely on coverage by the Association in selecting an insurance company or in selecting an insurance policy.

The following policies and persons are among those that are excluded from Association coverage:
 A policy or contract issued by an insurer that was not authorized to do business in California when it issued the policy or contract
 A policy issued by a health care service plan (HMO), a hospital or medical service organization, a charitable organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company, an insurance exchange, or a grants and annuities society
 If the person is provided coverage by the guaranty association of another state  Unallocated annuity contracts; that is, contracts which are not issued to and owned by an individual and which do not guaranty annuity benefits to an individual  Employer and association plans, to the extent they are self-funded or uninsured  A policy or contract providing any health care benefits under Medicare Part C or Part D
 An annuity issued by an organization that is only licensed to issue charitable gift annuities
 Any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as certain investment elements of a variable life insurance policy or a variable annuity contract  Any policy of reinsurance unless an assumption certificate was issued  Interest rate yields (including implied yields) that exceed limits that are specified in Insurance Code Section 1067.02(b)(2)(C).

NOTICES
Insurance companies or their agents are required by law to give or send you this notice.

Policyholders with additional questions should first contact their insurer or agent. To learn more about coverages provided by the Association, please visit the Association’s website at www.califega.org, or contact either of the following:

California Life and Health Insurance California Department of Insurance Guarantee Association Consumer Communications Bureau
PO Box 16860 300 South Spring Street
Beverly Hills, CA 90209-3319 Los Angeles CA 90013
(323) 782-0182 (800) 927-4357
Insurance companies and agents are not allowed by California law to use the existence of the Association or its coverage to solicit, induce or encourage you to purchase any form of insurance. When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between this notice and California law, then California law will control.

CALIFORNIA NOTICE OF COMPLAINT PROCEDURE
Should any dispute arise about your premium or about a claim that you have filed, write to the company that issued the group policy at:

Standard Insurance Company
PO Box 711
Portland, OR 97207
(503) 321-7000
If the problem is not resolved, you may also write to the State of California at:

Department of Insurance
Consumer Services Division
300 S. Spring Street, 9th FL
Los Angeles, CA 90013
1-800-927-HELP (4357)
www.insurance.ca.gov/0500-about-us/02-department/030-csmcb/consumerservices.cfm This notice of complaint procedure is for information only and does not become a part or condition of this group policy/certificate.

STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282
(503) 321-7000

GROUP LIFE INSURANCE POLICY
Policyholder: City Of Anaheim [actives]
Policy Number: 764999
Effective Date: January 1, 2027
The consideration for this Group Policy is the application of the Policyholder and the payment by the Policyholder of premiums as provided herein.

Subject to the Policyholder Provisions and the Incontestability Of Group Policy, this Group Policy (a) is issued for the Initial Rate Guarantee Period shown in the Coverage Features, and (b) may be renewed for successive renewal periods by the payment of the premium set by us on each renewal date. The length of each renewal period will be set by us, but will not be less than 12 months.

For purposes of effective dates and ending dates under this Group Policy, all days begin and end at 12:00 midnight Standard Time at the Policyholder's address.

This policy includes an Accelerated Death Benefit. Death benefits will be reduced if an Accelerated Death Benefit is paid. The receipt of this benefit may be taxable and may affect your eligibility for Medicaid or other government benefits or entitlements. However, if you meet the definition of “terminally ill individual” in Internal Revenue Code section 101, your Accelerated Death Benefit may be non-taxable. You should consult your personal tax and/or legal advisor before you apply for an Accelerated Death Benefit.

All provisions on this and the following pages are part of this Group Policy. Unless defined differently within a particular provision, the terms "you" and "your" mean the Member. "We", "us", and "our" mean Standard Insurance Company. Other defined terms appear with their initial letters capitalized. Section headings, and references to them, appear in bold face type.

STANDARD INSURANCE COMPANY
By
President and CEO Corporate Secretary
GP1219-LIFE

TABLE OF CONTENTS
COVERAGE FEATURES .............................................................................................................................. 1 PREMIUM RATES AND RENEWALS .................................................................................................... 1 GROUP POLICY ........................................................................................................................................... 3 INCONTESTABILITY OF GROUP POLICY ................................................................................................. 3 TERMINATION OR AMENDMENT OF THE GROUP POLICY .................................................................... 3 POLICYHOLDER PROVISIONS .................................................................................................................. 4 A. Premiums ........................................................................................................................................... 4 B. Contributions From Members ............................................................................................................. 4 C. Changes In Premium Rates ............................................................................................................... 4 D. Payment Of Premiums ....................................................................................................................... 4 E. Grace Period And Termination For Nonpayment ............................................................................... 4 F. Termination For Other Reasons ......................................................................................................... 4 G. Premium Adjustments ........................................................................................................................ 5 H. Certificates ......................................................................................................................................... 5 I. Records And Reports .......................................................................................................................... 5 J. Agency, Release And Indemnification ................................................................................................ 5 K. Notice Of Suit ..................................................................................................................................... 5 L. Entire Contract, Changes ................................................................................................................... 5 M. Effect On Workers' Compensation, State Disability Insurance ......................................................... 5 9/2026 1 764999

COVERAGE FEATURES

PREMIUM RATES AND RENEWALS
Premium Rates:

Premium Rates:

Life Insurance:

Plan 1: $0.035 monthly per $1,000 of Life Insurance
Plan 2:

Age of Member on Monthly Rate Per
Last January 1 Multiple of $1,000
Under 25 $ 0.060
25 through 29 0.060
30 through 34 0.060
35 through 39 0.080
40 through 44 0.120
45 through 49 0.200
50 through 54 0.300
55 through 59 0.480
60 through 64 0.600
65 through 69 1.100
70 through 74 1.840
75 or over 3.600
Dependents Life Insurance:

Plan 1 (Spouse and Child): $0.769 monthly per Member electing Plan 1 Dependents Life Insurance, regardless of the number covered.

Plan 2 (Spouse)
Age of Spouse on Monthly Rate Per
Last January 1 Multiple of $1,000
Under 25 $ 0.060
25 through 29 0.060
30 through 34 0.060
35 through 39 0.080
40 through 44 0.120
45 through 49 0.200
50 through 54 0.300
55 through 59 0.480
60 through 64 0.600
65 through 69 1.100
70 through 74 1.840
75 or over 3.600
AD&D Insurance: $0.010 monthly per $1,000 of AD&D Insurance 9/2026 2 764999
Premium Due Dates: January 1, 2027, and the first day of each calendar month thereafter.

Renewal Date: January 1
Grace Period: 60 days
Initial Rate Guarantee Period: January 1, 2027, to January 1, 2030 Notice of Rate Change: 180 days
Minimum Participation:

Life Insurance:

Number: 10 insured Members
Percentage:

Plan 1: 100% of Members eligible for Plan 1
Plan 2: The greater of 10 insured Members or 20% of Members eligible for Plan 2
Dependents Life Insurance:

Plan 1: 20% of insured Members with Dependents eligible for Plan 1 must elect to insure those Dependents
Plan 2: 20% of insured Members with Dependents eligible for Plan 2 must elect to insure those Dependents
9/2026 3 764999

GROUP POLICY
Group Policy means the entire contract between the Policyholder and us. We will provide benefits according to the terms of the Group Policy. The Group Policy consists of the following:

1. This group life insurance policy issued by us to the Policyholder and identified by the Group Policy Number.

2. The Policyholder’s attached application.

3. Group life insurance Certificates with the same Group Policy Number.

4. Any amendments to the Group Policy or Certificates.

The Policyholder’s rights or the rights of any Member will only be affected by provisions that are part of the Group Policy. Only an executive of Standard Insurance Company may bind us by making a promise or a representation; or accept a representation that relates to the Group Policy.

LI.GP.OT.1

INCONTESTABILITY OF GROUP POLICY
Any statement made by the Policyholder to obtain the Group Policy or made by an Employer to obtain coverage under the Group Policy is, in the absence of fraud, a representation and not a warranty.

No misrepresentation by the Policyholder or your Employer will be used to deny a claim or to deny the validity of the Group Policy unless all of the following requirements are met:

1. The Group Policy would not have been issued if we had known the truth.

2. We have given the Policyholder or your Employer a copy of a Written instrument signed by the Policyholder or your Employer which contains the misrepresentation.

LI.IN.OT.1

TERMINATION OR AMENDMENT OF THE GROUP POLICY
The Group Policy may be terminated by us or the Policyholder according to its terms. It will terminate automatically for nonpayment of premium.

The Policyholder may terminate the Group Policy in whole, and may terminate insurance for any class or group of Members, at any time by giving us Written notice. The effective date of the termination will be the date stated in the notice. If no date is stated in the notice, then the effective date of termination will be the last day of the calendar month for which the premium was paid.

Benefits under the Group Policy are limited to its terms, including any valid amendment. No change or amendment will be valid unless it is approved in Writing by one of our executive officers and given to the Policyholder for attachment to the Group Policy. If the terms of the Certificate differ from the Group Policy, the terms stated in the Group Policy will govern. The Policyholder, your Employer, and their respective employees or representatives have no right or authority to change or amend the Group Policy or to waive any of its terms or provisions without our signed, Written approval.

We may change the Group Policy in whole or in part when any change or clarification in law or governmental regulation affects our obligations under the Group Policy, or with the Policyholder's written consent.

Any such change or amendment of the Group Policy may apply to current or future Members or to any separate classes or groups of Members.

LI.TA.OT.1
9/2026 4 764999

POLICYHOLDER PROVISIONS
A. Premiums
The premium due on each Premium Due Date is the sum of the premiums for all persons then insured.

Premium Rates are shown in the Coverage Features.

B. Contributions From Members
The Policyholder determines the amount, if any, of each Member's contribution toward the cost of insurance.

C. Changes In Premium Rates
We may change Premium Rates at any time when:

1. A change or clarification in law or governmental regulation affects the amount payable under the Group Policy. Any such change in Premium Rates will reflect only the change in our obligations.

2. Factors material to underwriting the risk we assumed under the Group Policy, including, but not limited to, number of persons insured, age, Annual Earnings, gender and occupational classification, change by 25% or more.

3. We and the Policyholder mutually agree in writing to change Premium Rates.

Except as provided above, Premium Rates will not be changed during the Initial Rate Guarantee Period shown in the Coverage Features.

Thereafter, except as provided above, we may change Premium Rates upon advance Written notice to the Policyholder. The minimum advance notice is shown in the Coverage Features as Notice of Rate Change. Any such change in Premium Rates may be made effective on any Premium Due Date, but no such change will be made more than once in any contract year. Contract years are successive 12 month periods computed from the end of the Initial Rate Guarantee Period.

D. Payment Of Premiums
All premiums are due on the Premium Due Date shown in the Coverage Features.

Each premium is payable on or before its Premium Due Date directly to us. The payment of each premium by the Policyholder as it becomes due will maintain the Group Policy in force until the next Premium Due Date.

E. Grace Period And Termination For Nonpayment
If a premium is not paid on or before its Premium Due Date, it may be paid during the following Grace Period. The length of the Grace Period is shown in the Coverage Features. The Group Policy will remain in force during the Grace Period.

If the premium is not paid during the Grace Period, the Group Policy will terminate automatically at the end of the Grace Period.

The Policyholder is liable for premium during the Grace Period. We may charge interest at the legal rate for any premium which is not paid during the Grace Period, beginning with the first day after the Grace Period.

F. Termination For Other Reasons
The Policyholder may terminate the Group Policy by giving us Written notice. The effective date of termination will be the later of:

1. The date stated in the notice.

2. The date we receive the notice.

We may terminate the Group Policy as follows:
9/2026 5 764999

1. On any Premium Due Date if the number of persons insured is less than the Minimum Participation Number or less than the Minimum Participation Percentage shown in the Coverage Features.

2. On any Premium Due Date if we determine that the Policyholder has failed to promptly furnish any necessary information requested by us, or has failed to perform any other obligations relating to the Group Policy.

3. On any Premium Due Date by giving the Policyholder not less than 60 days advance Written notice.

The minimum advance notice of such termination by us is 60 days.

G. Premium Adjustments
Premium adjustments involving a return of unearned premiums to the Policyholder will be limited to the 12 months just before the date we receive a request for premium adjustment.

H. Certificates
We will issue printed or electronic Certificates to the Policyholder or Employer showing the coverage under the Group Policy. The Policyholder or Employer will distribute a certificate to each insured Member. If the terms of the Certificate differ from the Group Policy, the terms stated in the Group Policy will govern.

I. Records And Reports
The Policyholder or Employer will furnish on our forms all information reasonably necessary to administer the Group Policy. We have the right at all reasonable times to inspect the payroll and other records of the Policyholder or Employer which relate to insurance under the Group Policy.

J. Agency, Release And Indemnification
Individuals selected by the Policyholder or by any Employer to secure coverage under the Group Policy or to perform their administrative function under it, represent and act on behalf of the person selecting them, and do not represent or act on behalf of Standard Insurance Company. The Policyholder, Employer, and such individuals have no authority to alter, expand, or extend our liability or to waive, modify or compromise any defense or right we may have under the Group Policy. The Policyholder and Employer are liable for their own negligent, intentional or wrongful acts or omissions, and those of any insurance broker/agent or administrator acting for or on behalf of either of them, arising from or connected with the administration of the Group Policy. The Policyholder and each Employer hereby release, hold harmless, and indemnify Standard Insurance Company from any liability arising from or related to any negligence, error, omission, misrepresentation, or dishonesty of any of them or their representatives, agency, or employees.

K. Notice Of Suit
The Policyholder and Employer shall promptly give us Written notice of any lawsuit or other legal proceedings arising under the Group Policy.

L. Entire Contract, Changes
The Group Policy constitutes the entire contract between the parties. A copy of the Policyholder's application is attached to the Group Policy when issued.

The Group Policy may be changed in whole or in part. No change in the Group Policy will be valid unless it is approved in Writing by one of our executive officers and given to the Policyholder for attachment to the Group Policy. No agent has authority to change the Group Policy or to waive any of its provisions.

M. Effect On Workers' Compensation, State Disability Insurance The coverage provided under the Group Policy is not a substitute for coverage under a workers' compensation or state disability income benefit law and does not relieve the Policyholder or Employer of any obligation to provide such coverage.

LI.PH.OT.1

NOTICE OF PROTECTION PROVIDED BY CALIFORNIA LIFE AND HEALTH

INSURANCE GUARANTEE ASSOCIATION
This notice provides a brief summary regarding the protections provided to policyholders by the California Life and Health Insurance Guarantee Association ("the Association").

The purpose of the Association is to assure that policyholders will be protected, within certain limits, in the unlikely event that a member insurer of the Association becomes financially unable to meet its obligations. Insurance companies licensed in California to sell life insurance, health insurance, annuities and structured settlement annuities are members of the Association. The protection provided by the Association is not unlimited and is not a substitute for consumers’ care in selecting insurers. This protection was created under California law, which determines who and what is covered and the amounts of coverage.

Below is a brief summary of the coverages, exclusions and limits provided by the Association. This summary does not cover all provisions of the law; nor does it in any way change anyone’s rights or obligations or the rights or obligations of the Association.

COVERAGE
 Persons Covered
Generally, an individual is covered by the Association if the insurer was a member of the Association and the individual lives in California at the time the insurer is determined by a court to be insolvent. Coverage is also provided to policy beneficiaries, payees or assignees, whether or not they live in California  Amounts of Coverage
The basic coverage protections provided by the Association are as follows.  Life Insurance, Annuities and Structured Settlement Annuities For life insurance policies, annuities and structured settlement annuities, the Association will provide the following:
 Life Insurance
80% of death benefits but not to exceed $300,000
80% of cash surrender or withdrawal values but not to exceed $100,000  Annuities and Structured Settlement Annuities
80% of the present value of annuity benefits, including net cash withdrawal and net cash surrender values but not to exceed $250,000 The maximum amount of protection provided by the Association to an individual, for all life insurance, annuities and structured settlement annuities is $300,000, regardless of the number of policies or contracts covering the individual.
 Health Insurance
The maximum amount of protection provided by the Association to an individual, as of July 1, 2016, is $546,741. This amount will increase or decrease based upon changes in the health care cost component of the consumer price index to the date on which an insurer becomes an insolvent insurer. Changes to this amount will be posted on the Association’s website www.califega.org.

COVERAGE LIMITATIONS AND EXCLUSIONS FROM COVERAGE
The Association may not provide coverage for this policy. Coverage by the Association generally requires residency in California. You should not rely on coverage by the Association in selecting an insurance company or in selecting an insurance policy.

The following policies and persons are among those that are excluded from Association coverage:
 A policy or contract issued by an insurer that was not authorized to do business in California when it issued the policy or contract
 A policy issued by a health care service plan (HMO), a hospital or medical service organization, a charitable organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company, an insurance exchange, or a grants and annuities society
 If the person is provided coverage by the guaranty association of another state  Unallocated annuity contracts; that is, contracts which are not issued to and owned by an individual and which do not guaranty annuity benefits to an individual  Employer and association plans, to the extent they are self-funded or uninsured  A policy or contract providing any health care benefits under Medicare Part C or Part D
 An annuity issued by an organization that is only licensed to issue charitable gift annuities
 Any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as certain investment elements of a variable life insurance policy or a variable annuity contract  Any policy of reinsurance unless an assumption certificate was issued  Interest rate yields (including implied yields) that exceed limits that are specified in Insurance Code Section 1067.02(b)(2)(C).

NOTICES
Insurance companies or their agents are required by law to give or send you this notice.

Policyholders with additional questions should first contact their insurer or agent. To learn more about coverages provided by the Association, please visit the Association’s website at www.califega.org, or contact either of the following:

California Life and Health Insurance California Department of Insurance Guarantee Association Consumer Communications Bureau
PO Box 16860 300 South Spring Street
Beverly Hills, CA 90209-3319 Los Angeles CA 90013
(323) 782-0182 (800) 927-4357
Insurance companies and agents are not allowed by California law to use the existence of the Association or its coverage to solicit, induce or encourage you to purchase any form of insurance. When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between this notice and California law, then California law will control.

CALIFORNIA NOTICE OF COMPLAINT PROCEDURE
Should any dispute arise about your premium or about a claim that you have filed, write to the company that issued the group policy at:

Standard Insurance Company
PO Box 711
Portland, OR 97207
(503) 321-7000
If the problem is not resolved, you may also write to the State of California at:

Department of Insurance
Consumer Services Division
300 S. Spring Street, 9th FL
Los Angeles, CA 90013
1-800-927-HELP (4357)
www.insurance.ca.gov/0500-about-us/02-department/030-csmcb/consumerservices.cfm This notice of complaint procedure is for information only and does not become a part or condition of this group policy/certificate.

STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282
(503) 321-7000

CERTIFICATE

GROUP LIFE INSURANCE
Policyholder: City Of Anaheim
Policy Number: 764999 [actives]
Effective Date: January 1, 2027
Revision Date: Not applicable
The Group Policy has been issued to the Policyholder.

We certify that you will be insured as provided by the terms of your Employer’s coverage under the Group Policy. If the terms of this Certificate differs from the terms of your Employer’s coverage under the Group Policy, the latter will govern. If your coverage is changed by an amendment to the Group Policy, we will provide the Policyholder with a revised Certificate or other notice to be given to you.

This policy includes an Accelerated Death Benefit. Death benefits will be reduced if an Accelerated Death Benefit is paid. The receipt of this benefit may be taxable and may affect your eligibility for Medicaid or other government benefits or entitlements. However, if you meet the definition of “terminally ill individual” in Internal Revenue Code section 101, your Accelerated Death Benefit may be non-taxable. You should consult your personal tax and/or legal advisor before you apply for an Accelerated Death Benefit.

Possession of this Certificate does not necessarily mean you are insured. You are insured only if you meet the requirements set out in this Certificate.

Unless defined differently within a particular provision, the terms "you" and "your" mean the Member. "We", "us", and "our" mean Standard Insurance Company. Other defined terms appear with their initial letters capitalized. Section headings, and references to them, appear in bold face type.

If you are a resident of California and age 65 or older on the date your coverage under the Group Policy becomes effective, for which you are required to pay all or part of the premium, you have 30 days from the date you first receive your Certificate to cancel your coverage. Upon receiving your cancellation request, we will void coverage from its inception as if the Certificate had not been issued and we will refund any premiums paid.

President and CEO
GC1219-LIFE

TABLE OF CONTENTS
COVERAGE FEATURES .............................................................................................................................. 1 GENERAL POLICY INFORMATION ...................................................................................................... 1 BECOMING INSURED ........................................................................................................................... 1 PREMIUM CONTRIBUTIONS ................................................................................................................ 2 SCHEDULE OF INSURANCE ................................................................................................................ 2 REDUCTIONS IN INSURANCE ............................................................................................................. 4 OTHER AD&D BENEFITS ..................................................................................................................... 4 OTHER PROVISIONS ............................................................................................................................ 5 INSURING CLAUSE ..................................................................................................................................... 7 EVIDENCE OF INSURABILITY .................................................................................................................... 7 LIFE INSURANCE ........................................................................................................................................ 7 A. Amount Of Life Insurance .................................................................................................................. 7 B. When Life Insurance Becomes Effective ........................................................................................... 7 C. Changes In Life Insurance ................................................................................................................. 8 D. Suicide Exclusion ............................................................................................................................... 8 E. When Life Insurance Ends ................................................................................................................. 9 F. Reinstatement Of Life Insurance ........................................................................................................ 9 DEPENDENT LIFE INSURANCE FOR YOUR SPOUSE ............................................................................. 9 A. Amount Of Insurance ......................................................................................................................... 9 B. Insuring Your Spouse ......................................................................................................................... 9 C. Changes In Insurance ...................................................................................................................... 10 D. Exclusions ........................................................................................................................................ 11 E. When Insurance Ends ...................................................................................................................... 11 DEPENDENT LIFE INSURANCE FOR YOUR CHILD ............................................................................... 12 A. Amount Of Insurance ....................................................................................................................... 12 B. Insuring Your Child ........................................................................................................................... 12 C. Changes In Insurance ...................................................................................................................... 13 D. When Insurance Ends ...................................................................................................................... 13 REPATRIATION BENEFIT ......................................................................................................................... 13 ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE ................................................................ 14 A. Insuring Clause ................................................................................................................................ 14 B. Becoming Insured For AD&D Insurance .......................................................................................... 14 C. Changes In AD&D Insurance ........................................................................................................... 14 D. Definition Of Loss For AD&D Insurance .......................................................................................... 14 E. AD&D Insurance Exclusions ............................................................................................................ 15 F. Amount Payable ............................................................................................................................... 16 G. Other AD&D Benefits ....................................................................................................................... 16 H. When AD&D Insurance Ends ........................................................................................................... 18 ACTIVE WORK PROVISIONS.................................................................................................................... 19 CONTINUITY OF COVERAGE ................................................................................................................... 19 PORTABILITY OF INSURANCE ................................................................................................................ 19 STRIKE CONTINUATION ........................................................................................................................... 21 WAIVER OF PREMIUM .............................................................................................................................. 21 ACCELERATED DEATH BENEFIT ............................................................................................................ 23 RIGHT TO CONVERT ................................................................................................................................ 24 CLAIMS ....................................................................................................................................................... 25 ASSIGNMENT ............................................................................................................................................ 28 BENEFIT PAYMENT AND BENEFICIARY PROVISIONS ......................................................................... 28 RIGHT TO RECOVERY .............................................................................................................................. 30 CLAIMANT COOPERATION ...................................................................................................................... 30 AGENCY, RELEASE AND INDEMNIFICATION......................................................................................... 30 TIME LIMITS ON LEGAL ACTIONS ........................................................................................................... 30 INCONTESTABILITY OF INSURANCE ...................................................................................................... 31 CLERICAL ERROR, MISSTATEMENT AND AGENCY ............................................................................. 31 DEFINITIONS ............................................................................................................................................. 31

INDEX OF DEFINED TERMS
Active Work, Actively At Work, 20
AD&D Insurance, 32
Air Bag System, 17
Annual Earnings, 32
Automobile (Air Bag), 17
Automobile (Seat Belt), 19
Beneficiary, 29
Child, 33
Contributory, 33
Conversion Period, 25
Dependent, 33
Dependent Life Insurance, 33
Domestic Partner, 34
Eligibility Waiting Period, 33
Employer, 33
Evidence Of Insurability, 33
Group Policy, 33
Group Policy Effective Date, 1
Group Policy Number, 1
Helmet, 18
Hospital, 33
Injury, 33
Insurance (Accelerated Death Benefit), 25
Insurance (Right To Convert), 25
Insurance (Waiver Of Premium), 22
Life Insurance, 33
Line of Duty Accident, 19
Loss (Accidental Death and Dismemberment
Insurance), 15
Material Duties (Active Work), 20
Noncontributory, 34
Nursing Home, 34
Own Occupation, 20
Physician, 34
Policyholder, 1
Portable Event, 20
Pregnancy, 34
Prior Plan, 34
Proof Of Loss, 26
Public Safety Officer, 18
Public Transportation, 19
Qualifying Event, 25
Qualifying Medical Condition, 24
Recipient, 30
Seat Belt System, 19
Sickness, 34
Signed, 34
Spouse, 34
Totally Disabled (Waiver Of Premium), 22
Waiting Period, 22
War, 16
Writing or Written, 34
You and Your, 25
9/2026 1 764999

COVERAGE FEATURES
This section contains many of the features of your group life insurance. Other provisions, including exclusions and limitations, appear in other sections. Please refer to the text of each section for full details.

The Table of Contents and the Index of Defined Terms help locate sections and definitions.

GENERAL POLICY INFORMATION
Group Policy Number: 764999
Type of Insurance Provided:

Life Insurance: Yes
Accidental Death And
Dismemberment (AD&D) Insurance: Yes
Dependent Life Insurance
For Your Spouse: Yes
Dependent Life Insurance
For Your Child: Yes
Policyholder: City Of Anaheim
Employer(S): City Of Anaheim
Group Policy Effective Date: January 1, 2027
Revision Date: Not applicable
State of Issue: California

BECOMING INSURED
To become insured for Life Insurance you must: (a) Be a Member; (b) Complete your Eligibility Waiting Period; and (c) Meet the requirements in Life Insurance and Active Work Provisions. The requirements for becoming insured for coverages other than Life Insurance are set out in the text.

Member means one of the following:

1. A regular full-time employee of the Employer who is Actively At Work at least 40 hours each week; or

2. An active mayor or city council member of the Employer.

For the purposes of the Member definition, Actively At Work will include regularly scheduled days off, holidays, or vacation days, so long as the person is capable of Active Work on those days.

You are not a Member if you are:

1. A temporary or seasonal employee.

2. A full-time member of the armed forces of any country.

3. A leased employee.

4. An independent contractor.

Class Definition:

Class 1: Mayor, City Council and City Manager
9/2026 2 764999
Class 2: Administrative or executive management Members Class 3: Professional, middle management, and supervisory Members
Class 4: All other Members
Eligibility Waiting Period: If you are a Member on the Group Policy Effective Date, you are eligible on that date. If you become a Member
after the Group Policy Effective Date, you are eligible on the first day following 90 consecutive days as a Member.

If you were insured under the Prior Plan on the day before the effective date of your Employer’s coverage under the Group Policy, your Eligibility Waiting Period is waived on the effective date of your Employer’s coverage under the Group Policy.

PREMIUM CONTRIBUTIONS
Life Insurance:

Plan 1: Contributory
Plan 2: Contributory
Dependent Life Insurance:

Plan 1: Contributory
Plan 2:

For Your Spouse: Contributory
AD&D Insurance: Contributory

SCHEDULE OF INSURANCE

SCHEDULE OF LIFE INSURANCE
For you:

Life Insurance Benefit:

You will become insured under Plan 1 if you meet the requirements to become insured under the Group Policy.

If you are an active Member and insured under Plan 1, you may also become insured under Plan 2 if you meet the requirements to become insured under Plan 2 Life Insurance under the Group Policy. Plan 2 is a Contributory plan requiring premium contributions from Members.

A Member may not be insured as both an active Member and a retired Member. Retired members are not eligible for Plan 2 Life Insurance.

Plan 1 (basic):

Class 1: 3 times your Annual Earnings, rounded to the next higher multiple of $50,000, if not already a multiple of $50,000.

The maximum amount is $750,000 and the minimum
amount is $10,000.

Class 2: 2 times your Annual Earnings, rounded to the next higher multiple of $50,000, if not already a multiple of $50,000.

The maximum amount is $750,000 and the minimum
amount is $10,000.
9/2026 3 764999
Class 3: 2 times your Annual Earnings, rounded to the next higher multiple of $50,000, if not already a multiple of $50,000.

The maximum amount is $600,000 and the minimum
amount is $10,000.

Class 4: $50,000.

Plan 2 (supplemental): You may apply for Life Insurance in multiples of $50,000, from $50,000 to a maximum of $750,000 when combined
with your Plan 1 Life Insurance Benefit.

The combined maximum benefit of your Plan 1 (basic) and Plan 2 (supplemental) Life Insurance Benefit may is the lesser of $750,000 or 7 times your Annual Earnings.

SCHEDULE OF DEPENDENT LIFE INSURANCE
If you are an active Member and insured under Plan 1 Life Insurance, your Dependents are eligible for Plan 1 Dependents Life Insurance for your Spouse and Dependents Life Insurance for your Child.

If you are insured under Plan 2 Life Insurance, you may apply for Plan 2 Dependent Life Insurance for your Spouse.

For your Spouse:

Spouse Life Insurance Benefit:

Plan 1: $10,000
The amount of Plan 1 Dependent Life Insurance for your Spouse may not exceed 50% of the amount of your Plan 1 Life Insurance.

Plan 2: You may apply for Dependent Life Insurance in multiples of $25,000 from $25,000 to $250,000.

The amount of Plan 2 Dependent Life Insurance for your Spouse may not exceed 50% of the amount of your Plan 2 Life Insurance.

For your Child:

Child Life Insurance Benefit: $10,000
The amount of Dependent Life Insurance for your Child may not exceed 50% of the amount of your Plan 1 Life Insurance.

SCHEDULE OF AD&D INSURANCE
The amount payable for certain Losses is less than 100% of the AD&D Insurance Benefit for you. See AD&D Table Of Losses below. Retired Members are not eligible for AD&D Insurance.

For you:

AD&D Insurance Benefit: If you are insured for Plan 1 Life Insurance, the amount of your AD&D Insurance Benefit is equal to the amount of
your Plan 1 Life Insurance Benefit.

AD&D TABLE OF LOSSES
The amount payable is a percentage of the AD&D Insurance Benefit in effect on the date of the accident and is determined by the Loss suffered as shown in the following table:

Loss: Percentage Payable:
a. Life: 100%
b. One hand or one foot: 50%**
c. Sight in one eye, speech,
or hearing in both ears 50%
9/2026 4 764999
c. Speech and
hearing in both ears 100%
e. One arm or one leg 75%**
f. Two or more of the Losses listed
above 100%
g. Thumb and index finger of the
same hand 25%*
h. Four fingers of the same hand 20%*
i. All toes of the same foot 20%*
j. Thumb or the fifth finger (pinky) 15%*
k. Quadriplegia 100%
l. Triplegia 75%
m. Paraplegia 75%
n. Hemiplegia 50%
o. Uniplegia 25%
p. Coma For the first 11 months, 5% per month of the remainder of the AD&D Insurance Benefit payable for Loss of life after reduction by any AD&D Insurance Benefit paid for any
other Loss as a result of the same accident. The unpaid portion of the remaining AD&D Insurance Benefit will be paid in month 12. Payments for coma will not exceed a
maximum of 12 months.

No more than 100% of the AD&D Insurance Benefit will be paid for all Losses resulting from one accident.
* No AD&D Insurance Benefit will be paid for Loss of one or more fingers, the thumb, one or more toes, or the thumb and index finger of the same hand if an AD&D Insurance Benefit is payable for the Loss of that entire hand or foot. No AD&D Insurance Benefit will be paid for Loss of a hand or foot, one or more fingers, the thumb, one or more toes, or the thumb and index finger of the same hand if an AD&D Insurance Benefit is payable for the Loss of that entire arm or leg. ** If you lose an arm, leg, a hand or foot and an AD&D Insurance Benefit is payable for Quadriplegia, Hemiplegia, Uniplegia, Triplegia, or Paraplegia involving that same arm, leg, hand or foot, we will pay the higher of the AD&D Insurance Benefits for that Loss.

REDUCTIONS IN INSURANCE
Your insurance will not be reduced because of your age unless your insurance is subject to termination under the Waiver of Premium provision.

OTHER AD&D BENEFITS
Air Bag Benefit:

For you: The lesser of (1) $5,000; or (2) 5% of the amount of AD&D Insurance Benefit otherwise payable for Loss of that life. 9/2026 5 764999
Assault Benefit:

For you: The lesser of (1) $25,000; or (2) 50% of the amount of the AD&D Insurance Benefit otherwise payable for the Loss.

Career Adjustment Benefit:

For you: The tuition expenses for training incurred by your Spouse within 36 months after the date of your death, exclusive of board and room, books, fees, supplies and other
expenses, but not to exceed $5,000 per year, or the
cumulative total of $10,000 or 25% of the AD&D
Insurance Benefit, whichever is less.

Child Care Benefit:

For you: The total child care expense incurred by your Spouse within 36 months after the date of your death for all
Children under age 13, but not to exceed $5,000 per year, or the cumulative total of $10,000 or 25% of the AD&D
Insurance Benefit, whichever is less.

Helmet Benefit:

For you: The lesser of (1) $5,000; or (2) 10% of the amount of AD&D Insurance Benefit otherwise payable for Loss of
that life.

Higher Education Benefit:

For you: The tuition expenses incurred per Child within 4 years after the date of your death at an accredited institution of higher education, exclusive of board and room, books,
fees, supplies and other expenses, but not to exceed
$5,000 per year, or the cumulative total of $20,000 or 25% of the AD&D Insurance Benefit, whichever is less.

Line Of Duty Benefit:

For you: The lesser of (1) $50,000; or (2) 100% of the amount of the AD&D Insurance Benefit otherwise payable for the
Loss.

Public Transportation Benefit:

For you: The lesser of (1) $200,000; or (2) 100% of the amount of the AD&D Insurance Benefit otherwise payable for Loss
of that life.

Seat Belt Benefit:

For you: The lesser of (1) $25,000; or (2) 10% of the amount of AD&D Insurance Benefit otherwise payable for Loss of
that life.

OTHER PROVISIONS
Repatriation Benefit: The lesser of (1) $5,000; or (2) 100% of the expenses incurred to transport your body to a mortuary near your primary place of residence including expenses to prepare the body for shipment.

Waiver Of Premium: Yes
9/2026 6 764999
Accelerated Death Benefit: Yes
Insurance Eligible For Portability:

For you:

Life Insurance: Yes
Minimum amount $10,000
Maximum amount $500,000
AD&D Insurance: Yes
Minimum amount $10,000
Maximum amount $500,000
For your Spouse:

Dependent Life Insurance: Yes
Minimum amount $5,000
Maximum amount $250,000
Suicide Exclusion: Applies to:
a. Plan 2 Life Insurance
b. Dependent Life Insurance For Your Spouse
c. AD&D Insurance
See Accidental Death And Dismemberment Insurance for other exclusions Strike Continuation: Yes. The Strike Continuation premium is 120% of the Premium Rate.
9/2026 7 764999

INSURING CLAUSE
If you, your Spouse or your Child die or have a loss while insured under the Group Policy, we will pay benefits according to the terms of the Group Policy after we receive Proof Of Loss satisfactory to us, subject to the Claims provision.

LI.IC.OT.1

EVIDENCE OF INSURABILITY
A. Evidence of Insurability will be required as follows:

1. If you apply for Contributory Life Insurance for yourself, Dependent Life Insurance for your Spouse, or Dependent Life Insurance for your Child more than 31 days after you become eligible.

2. For any Plan 2 Life Insurance Benefit in excess of the Guarantee Issue Amount of $250,000.

3. For any Plan 2 Spouse Life Insurance Benefit in excess of the Guarantee Issue Amount of $50,000.

4. For reinstatements, if required.

5. For Members, a Spouse, or a Child eligible, but not insured under the Prior Plan.

6. For any increase in Plan 2 Life Insurance or Spouse Life Insurance Benefit resulting from a plan or option change you elect.

B. Evidence Of Insurability will not be required as follows:

1. If you or your Spouse were insured under the Prior Plan for an amount in excess of the Guarantee Issue Amount on the day before the Group Policy Effective Date, the Evidence Of Insurability requirement will be waived for you for that amount on the Group Policy Effective Date.

2. One Time Open Enrollment
Your Employer will hold a One Time Open Enrollment prior to the Group Policy Effective Date.

During this One Time Open Enrollment, the following will not require Evidence Of Insurability as long as your total Plan 2 Life Insurance Benefit or your total Plan 2 Spouse Life Insurance Benefit after an election, does not exceed the Guarantee Issue Amount described above. a. For those insured or eligible for additional life under the Prior Plan, you may apply or increase Plan 2 Life Insurance up to the Guarantee Issue Amount. b. For a Spouse who is insured or eligible for additional dependent life under the Prior Plan, you may apply or increase your Plan 2 Spouse Life Insurance Benefit up to the Guarantee Issue Amount.

LI.EOI.OT.1

LIFE INSURANCE
A. Amount Of Life Insurance
See Coverage Features for the Life Insurance schedule.

B. When Life Insurance Becomes Effective
The Coverage Features states whether your Life Insurance is Contributory or Noncontributory.

Subject to the Active Work Provisions, your Life Insurance becomes effective as follows:

1. Life Insurance Subject To Evidence Of Insurability
Life Insurance subject to Evidence Of Insurability becomes effective on the date we approve your Evidence Of Insurability.

2. Life Insurance Not Subject To Evidence Of Insurability 9/2026 8 764999
a. Noncontributory Life Insurance
Noncontributory Life Insurance not subject to Evidence Of Insurability becomes effective on the date you become eligible.
b. Contributory Life Insurance
You must apply in Writing for Contributory Life Insurance and agree to pay premiums.

Contributory Life Insurance not subject to Evidence Of Insurability becomes effective on:
i. The date you become eligible if you apply on or before that date. ii. The date you apply if you apply within 31 days after you become eligible.

C. Changes In Life Insurance

1. Increases
You must apply in Writing for any elective increase in your Life Insurance.

Subject to the Active Work Provisions, an increase in your Life Insurance becomes effective as follows:
a. Increases Subject To Evidence Of Insurability
An increase in your Life Insurance subject to Evidence Of Insurability becomes effective on the date we approve your Evidence Of Insurability.
b. Increases Not Subject To Evidence Of Insurability
An increase in your Life Insurance not subject to Evidence Of Insurability becomes effective as follows:
i. The date of change in your classification.
ii. The date of the change in your Annual Earnings.
iii. The date you apply for an elective increase.
v. The beginning of the next plan year following the date you apply, if you apply during the One Time Open Enrollment Period.

2. Decreases
a. A decrease in your Life Insurance because of a change in your classification becomes effective on the date of the change.
b. A decrease in your Life Insurance because of a change in your age becomes effective on the date of the change.
c. A decrease in your Life Insurance because of a change in your Annual Earnings becomes effective on the date of the change.
d. Any other decrease in your Life Insurance becomes effective on the date the Policyholder or your Employer receives your Written request for the decrease.

D. Suicide Exclusion: Life Insurance
The Coverage Features states which Life Insurance plan is subject to this suicide exclusion.

If your death results from suicide or other intentionally self-inflicted injury, while sane or insane, 1 and 2 below apply.

1. The amount payable will exclude the amount of your Life Insurance which is subject to this suicide exclusion and which has not been continuously in effect for at least 2 years on the date of your death. In computing the 2-year period, we will include time you were insured under the Prior Plan. 9/2026 9 764999

2. We will refund all premiums paid for that portion of your Life Insurance which is excluded from payment under this suicide exclusion.

E. When Life Insurance Ends
Your Life Insurance ends automatically on the earliest of:

1. The date the last period ends for which a premium was paid for your Life Insurance.

2. The date the Group Policy terminates.

3. The date your Employer’s coverage under the Group Policy terminates.

4. The date your employment terminates, unless you are covered as a retired Member.

5. The date you cease to be a Member. However, if you cease to be a Member because you are working less than the required minimum number of hours, your Life Insurance will be continued with premium payment during the following periods, unless it ends under 1 through 4 above. a. While your Employer is paying you at least the same Annual Earnings paid to you immediately before you ceased to be a Member.
b. During the first 12 months while your ability to work is limited because of Sickness, accidental Injury, or Pregnancy.
c. During the first 60 days of a temporary layoff.
d. During a leave of absence under any applicable state or federally mandated family or medical leave act or law.
e. During any other scheduled leave of absence approved by your Employer in advance and in Writing and scheduled to last 60 days or less.

F. Reinstatement Of Life Insurance
If your Life Insurance ends, you may become insured again as a new Member. However, the following will apply:

1. If your Life Insurance ends because you cease to be a Member, and if you become a Member again within 90 days, the Eligibility Waiting Period will be waived.

2. If your Life Insurance ends because you cease to be a Member, and you become a Member again within 90 days, your Life Insurance amounts in effect prior to your last day of Active Work will be reinstated without Evidence Of Insurability.

3. If your Life Insurance ends because you fail to make a required premium contribution, you must provide Evidence Of Insurability to become insured again.

4. If you exercised your Right To Convert, you must provide Evidence Of Insurability to become insured again.

5. If your Life Insurance ends because you are on a federal or state-mandated family or medical leave of absence, and you become a Member again immediately following the period allowed, your insurance will be reinstated pursuant to the federal or state-mandated family or medical leave act or law.

LI.LF.OT.1

DEPENDENT LIFE INSURANCE FOR YOUR SPOUSE
A. Amount Of Insurance
See Coverage Features for the Insurance amount.

B. Insuring Your Spouse

1. Eligibility
9/2026 10 764999
You become eligible to insure your Spouse on the later of:
a. The date you become eligible for Life Insurance.
b. The date you first acquire a Spouse.

A Member may be insured as both a Member and a Spouse.

2. Effective Date
The Coverage Features states whether your Dependent Life Insurance for your Spouse is Contributory or Noncontributory. Subject to the Active Work Provisions and the Dependent Deferred Effective Date If Confined section, your Dependent Life Insurance for your Spouse becomes effective as follows:
a. Insurance Subject To Evidence Of Insurability
Insurance subject to Evidence Of Insurability becomes effective on the later of:
i. The date your Life Insurance becomes effective.
ii. The date we approve the Spouse's Evidence Of Insurability. b. Insurance Not Subject To Evidence Of Insurability
i. Noncontributory Insurance
Noncontributory Insurance not subject to Evidence Of Insurability becomes effective on the later of:
* The date your Life Insurance becomes effective.
* The date you first acquire a Spouse.
ii. Contributory Insurance
You must apply in Writing for Contributory Dependent Life Insurance for your Spouse and agree to pay premiums. Contributory Dependent Life Insurance for your Spouse not subject to Evidence Of Insurability becomes effective on the latest of:
* The date your Life Insurance becomes effective if you apply on or before that date. * The date you become eligible to insure your Spouse if you apply on or before that date. * The date you apply if you apply within 31 days after you become eligible. c. Dependent Deferred Effective Date If Confined
Dependent Life Insurance for your Spouse and increases in Dependent Life Insurance for your Spouse will not become effective for your Spouse who is confined to a Hospital or Nursing Home on the day before the scheduled effective date of your Spouse's Insurance or the effective date of the increase in Dependent Life Insurance for your Spouse.

You may apply in Writing and agree to pay premiums for Contributory Insurance for your Spouse within 31 days of the date you are eligible to apply for Insurance for your Spouse without submitting Evidence Of Insurability. Coverage will become effective on the date the Spouse is released from a Hospital or Nursing Home. If you do not apply within this period, you must submit Evidence Of Insurability with your application.

This section will not apply to Dependent Life Insurance for your Spouse equal to the amount of dependent life insurance in effect under the Prior Plan on the date before the Group Policy Effective Date.

C. Changes In Insurance

1. Increases
9/2026 11 764999
You must apply in Writing for any elective increase in your Dependent Life Insurance for your Spouse.

Subject to the Active Work Provisions and the Dependent Deferred Effective Date If Confined section, an increase in your Insurance for your Spouse becomes effective as follows:
a. Increases Subject To Evidence Of Insurability
An increase in the Spouse Life Insurance Benefit subject to Evidence Of Insurability becomes effective on the date we approve your Spouse's Evidence Of Insurability. b. Increases Not Subject To Evidence Of Insurability
An increase in your Dependent Life Insurance for your Spouse not subject to Evidence Of Insurability becomes effective as follows:
i. The date of the change in your classification.
ii. The date of the change in your Annual Earnings.
iii. The date you apply for an elective increase.
iv. The beginning of the next plan year following the date you apply, if you apply during the One Time Open Enrollment Period.

2. Decreases
a. A decrease in the Spouse Life Insurance Benefit because of a decrease in your Life Insurance becomes effective on the date your Life Insurance decreases. b. A decrease in the Spouse Life Insurance Benefit because of a change in age becomes effective on the date of the change in age.
c. A decrease in the Spouse Life Insurance Benefit because of a change in your classification becomes effective on the date of the change in your classification. d. Any other decrease in the Spouse Life Insurance Benefit becomes effective on the date the Policyholder or Employer receives your Written request for the decrease.

D. Exclusions
If your Spouse's death results from suicide or other intentionally self-inflicted injury, while sane or insane, 1. and 2. below will apply.

1. The amount payable will exclude the amount of Dependent Life Insurance which has not been continuously in effect for your Spouse for at least 2 years on the date of death. In computing the 2- year period, we will include time your Spouse was insured under the Prior Plan.

2. We will refund all premiums paid for the amount of Dependent Life Insurance excluded from payment under this suicide exclusion which we determine are attributable to your Spouse.

E. When Insurance Ends
Insurance ends automatically on the earliest of:

1. Five months after you die. (No premium will be charged for your Dependent Life Insurance for your Spouse during this time.)

2. The date your Life Insurance ends.

3. The date Dependent Life Insurance for your Spouse terminates under the Group Policy, unless your Insurance continues under item 1 above.

4. The date the Group Policy terminates, or the date Employer’s coverage under the Group Policy for your Spouse terminates, unless Insurance continues under item 1 above.

5. The date the last period ends for which a premium was paid for your Dependent Life Insurance for your Spouse, unless it continues under item 1 above.
9/2026 12 764999

6. The last day for which premium contributions have been paid following your Written request to terminate your Dependent Life Insurance for your Spouse.

7. For your Spouse, the date of your divorce or legal separation or termination of your Domestic Partner relationship.

LI.SP.OT.1

DEPENDENT LIFE INSURANCE FOR YOUR CHILD
A. Amount Of Insurance
See Coverage Features for the Insurance amount.

B. Insuring Your Child

1. Eligibility
You become eligible to insure your Child on the later of:
a. The date you become eligible for Life Insurance.
b. The date you first acquire a Child.

A Member may be insured as both a Member and a Child. A Child may be insured by more than one Member. For purposes of insurance under the Group Policy, Child does not include a person who is a full-time member of the armed forces of any country.

2. Effective Date
The Coverage Features states whether your Dependent Life Insurance for your Child is Contributory or Noncontributory. Subject to the Active Work Provisions, your Dependent Life Insurance for your Child becomes effective as follows:
a. Insurance Subject To Evidence Of Insurability
Insurance subject to Evidence Of Insurability becomes effective on the later of:
i. The date your Life Insurance becomes effective.
ii. The date we approve the Child's Evidence Of Insurability. b. Insurance Not Subject To Evidence Of Insurability
i. Noncontributory Insurance
Noncontributory Insurance not subject to Evidence Of Insurability becomes effective on the later of:
* The date your Life Insurance becomes effective.
* The date you first acquire a Child.
ii. Contributory Insurance
You must apply in Writing for Dependent Life Insurance for your Child and agree to pay premiums. Contributory Insurance for your Child not subject to Evidence Of Insurability becomes effective on the latest of:
* The date your Life Insurance becomes effective if you apply on or before that date. * The date you become eligible to insure your Child if you apply on or before that date. * The date you apply if you apply within 31 days after you become eligible.

Except as provided above, your first eligible newborn Child is automatically covered for the minimum Child Life Insurance Benefit amount shown in the Coverage Features up to the date you apply, if you apply within 31 days from the Child’s live birth. 9/2026 13 764999
c. While your Dependent Life Insurance for your Child is in effect, each new Child becomes insured immediately.

C. Changes In Insurance

1. Increases
You must apply in Writing for any elective increase in your insurance for your Child.

Subject to the Active Work Provisions, an increase in your Child’s Insurance becomes effective as follows:
a. Increases Subject To Evidence Of Insurability
An increase in the Child Life Insurance Benefit subject to Evidence Of Insurability becomes effective on the date we approve your Child’s Evidence Of Insurability. b. Increases Not Subject To Evidence Of Insurability
An increase in your Dependent Life Insurance for your Child not subject to Evidence Of Insurability becomes effective as follows:
i. of the change in your classification.
ii. The date of the change in your Annual Earnings.
iii. you apply for an elective increase.

2. Decreases
a. A decrease in the Child Life Insurance Benefit because of a decrease in your Life Insurance becomes effective on your Life Insurance decreases.
b. Any other decrease in the Child Life Insurance Benefit becomes effective on the Policyholder or Employer receives your Written request for the decrease.

D. When Insurance Ends
Insurance ends automatically on the earliest of:

1. Five months after you die. (No premium will be charged for your Dependent Life Insurance for your Child during this time.)

2. The date your Life Insurance ends.

3. The date Dependent Life Insurance for your Child terminates under the Group Policy, unless your Insurance continues under item 1 above.

4. The date the Group Policy terminates, or the date Employer’s coverage under the Group Policy for your Child terminates, unless Insurance continues under item 1 above.

5. The date the last period ends for which a premium was paid for your Dependent Life Insurance for your Child, unless it continues under item 1 above.

6. The last day for which premium contributions have been paid following your Written request to terminate your Dependent Life Insurance for your Child.

7. For any Child, the date the Child ceases to be a Child.

LI.CH.OT.1

REPATRIATION BENEFIT
The amount of the Repatriation Benefit is shown in the Coverage Features.

We will pay a Repatriation Benefit if all of the following requirements are met:

1. A Life Insurance Benefit is payable because of your death. 9/2026 14 764999

2. You die more than 200 miles from your primary place of residence.

3. Expenses are incurred to transport your body to a mortuary near your primary place of residence, including expenses to prepare the body for shipment.

LI.RB.OT.1

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE
A. Insuring Clause
If you have an accident including accidental exposure to adverse weather conditions, while insured for AD&D Insurance under the Group Policy, and the accident results in a Loss, we will pay benefits according to the terms of the Group Policy after we receive Proof Of Loss satisfactory to us, subject to the Claims provision.

B. Becoming Insured For AD&D Insurance

1. Eligibility
a. Noncontributory AD&D Insurance
You become eligible for Noncontributory AD&D Insurance on the date your Noncontributory Life Insurance is effective.
b. Contributory AD&D Insurance
You are eligible for Contributory AD&D Insurance on the date your Contributory Life Insurance is effective.

2. Effective Date
The Coverage Features states whether AD&D Insurance is Contributory or Noncontributory.

Subject to the Active Work Provisions, AD&D Insurance becomes effective as follows:
a. Noncontributory AD&D Insurance
Noncontributory AD&D Insurance becomes effective on the date you become eligible. b. Contributory AD&D Insurance
You must apply in Writing for Contributory AD&D Insurance and agree to pay premiums.

Contributory AD&D Insurance becomes effective on the later of:
i. The date you become eligible if you apply on or before that date. ii. The date you apply, if you apply after you become eligible.

C. Changes In AD&D Insurance
Changes in your AD&D Insurance will become effective on the date your Life Insurance changes.

D. Definition Of Loss For AD&D Insurance
Loss means loss of life, hand, foot, sight, speech, hearing in both ears, arm, leg, thumb, thumb and index finger of the same hand, fingers, toes, coma, Quadriplegia, Hemiplegia, Uniplegia, Triplegia, and Paraplegia which meets all of the following requirements:

1. Is caused solely and directly by an accident.

2. Occurs independently of all other causes.

3. Occurs within 365 days after the accident.

4. With respect to Loss of life, is evidenced by Proof Of Loss satisfactory to us.

5. With respect to all other Losses, is certified by a Physician in the appropriate specialty as determined by us.
9/2026 15 764999
With respect to Loss of life, death will be presumed if you disappear and the disappearance meets all of the following requirements:

1. Is caused solely and directly by an accident that reasonably could have caused Loss of life.

2. Occurs independently of all other causes.

3. Continues for a period of 365 days after the date of the accident, despite reasonable search efforts.

With respect to a hand or foot, Loss means actual and permanent severance from the body at or above the wrist or ankle joint, whether or not surgically reattached.

With respect to an arm or leg, Loss means actual and permanent severance from the body at or below the shoulder or hip joint, whether or not surgically reattached.

With respect to sight, Loss means entire, uncorrectable, and irrecoverable loss of sight.

With respect to speech, Loss means entire, uncorrectable, and irrecoverable loss of audible speech.

With respect to hearing, Loss means entire, uncorrectable, and irrecoverable loss of hearing in both ears.

With respect to thumb and index finger of the same hand, Loss means actual and permanent severance from the body at or above the metacarpophalangeal joints.

With respect to 4 fingers of the same hand, Loss means actual and permanent severance from the body at or above the metacarpophalangeal joints.

With respect to the fifth finger (pinky finger) or thumb, Loss means the actual and permanent severance from the body at or above the metacarpophalangeal joint.

With respect to all toes of the same foot, Loss means actual and permanent severance from the body at or above the metatarsophalangeal joint.

With respect to coma, Loss means profound state of mental unconsciousness with no evidence of appropriate responses to stimulation, lasting for at least 21 consecutive days. Benefits payable because of a coma will end the earliest of the time period shown in the Coverage Features, or you or your Dependent regain consciousness, or you or your Dependent die.

With respect to Quadriplegia, Hemiplegia, Uniplegia, Triplegia, and Paraplegia, Loss must be permanent, complete, and irreversible.

Quadriplegia means total paralysis of both upper and lower limbs. Hemiplegia means total paralysis of the upper and lower limbs on the same side of the body. Paraplegia means total paralysis of both lower limbs. Uniplegia means the complete and irreversible paralysis of one limb. Triplegia means the complete and irreversible paralysis of three limbs.

E. AD&D Insurance Exclusions
No AD&D Insurance Benefit is payable if the accident or Loss is caused or contributed to by any of the following:

1. War or act of War. War means declared or undeclared war, whether civil or international, and any substantial armed conflict between organized forces of a military nature.

2. Suicide or other intentionally self-inflicted Injury, while sane or insane.

3. Committing or attempting to commit an assault or felony, or actively participating in a violent disorder or riot. Actively participating does not include being at the scene of a violent disorder or riot while performing your official duties.

4. The voluntary intake by any means of any poison, gas, fumes, prescription drugs, non-prescription drugs or illegal drugs, unless prescribed or taken under the direction of a Physician and taken in accordance with the Physician’s instructions.
9/2026 16 764999

5. Alcohol – if your blood alcohol content is in excess of the legal limit for operating a motor vehicle as defined by the jurisdiction where the accident or Loss occurred. This exclusion applies regardless of whether the accident or Loss involved the operation of a motor vehicle.

6. Sickness or Pregnancy existing at the time of the accident or a heart attack or stroke.

7. Medical or surgical treatment for any of the above.

F. Amount Payable
See Coverage Features for the AD&D Insurance schedule. The amount payable is a percentage of the AD&D Insurance Benefit in effect on the date of the accident and is determined by the Loss suffered.

See AD&D Table Of Losses in the Coverage Features.

G. Other AD&D Benefits
Air Bag Benefit
The amount of the Air Bag Benefit is shown in the Coverage Features.

We will pay an Air Bag Benefit if all of the following requirements are met:

1. You die as a result of an Automobile accident for which a Seat Belt Benefit is payable for Loss of your life.

2. The Automobile is equipped with an Air Bag System that was installed as original equipment by the Automobile manufacturer and has received regular maintenance or scheduled replacement as recommended by the Automobile or Air Bag System manufacturer.

3. You are seated in the driver's or a passenger's seating position intended to be protected by the Air Bag System and the Air Bag System deploys, as evidenced by Proof Of Loss satisfactory to us.

Air Bag System means an automatically inflatable passive restraint system that is designed to provide automatic crash protection in front or side impact Automobile accidents and meets the Federal Vehicle Safety Standards of the National Highway Traffic Safety Administration.

Automobile means a motor vehicle licensed for use on public highways.

Assault Benefit
The amount of the Assault Benefit is shown in the Coverage Features.

We will pay an Assault Benefit if a Loss occurs that is the result of an act of physical violence against you that is punishable by law and is evidence by a police report and the following requirement is met: while Actively At Work, you suffer a Loss for which an AD&D Insurance Benefit is payable.

Career Adjustment Benefit
The amount of the Career Adjustment Benefit is shown in the Coverage Features.

We will pay a Career Adjustment Benefit to your Spouse if all of the following requirements are met:

1. You die as a result of an accident for which an AD&D Insurance Benefit is payable for Loss of your life.

2. Your Spouse is, within 36 months after the date of your death, registered and in attendance at an accredited institution of higher education or trades training program for the purpose of obtaining employment or increasing earnings.

No Career Adjustment Benefit will be paid if you have no surviving Spouse.

Child Care Benefit
The amount of the Child Care Benefit is shown in the Coverage Features. 9/2026 17 764999
We will pay a Child Care Benefit to your Spouse if all of the following requirements are met:

1. You die as a result of an accident for which an AD&D Insurance Benefit is payable for Loss of your life.

2. Your Spouse pays a licensed child care provider who is not a member of your family for child care provided to your Child under age 13 within 36 months of your death.

3. The child care is necessary in order for your Spouse to work or to obtain training for work or to increase earnings.

No Child Care Benefit will be paid if you have no surviving Spouse.

Helmet Benefit
The amount of the Helmet Benefit is shown in the Coverage Features.

We will pay a Helmet Benefit if you meet all of the following requirements:

1. An AD&D Loss of life occurs while operating or riding a motorcycle or bicycle for which an AD&D Insurance Benefit is payable.

2. Wearing a Helmet at the time of the Loss as evidenced by a police accident report, medical examiner report, or coroner’s report.

3. The operator of the motorcycle has a current and valid driver’s license at the time of the Loss.

Helmet means protective headgear that meets or exceeds the standards established by the Code of Federal Regulations (CFR) in Title 16 Part 1203, Snell Memorial Foundation Standards M-95 or M2000, the American National Standards Institute specification Z 90. 1, or the United States Department of Transportation’s Federal Motor Vehicle Safety Standard No. 218, as amended and updated.

Higher Education Benefit
The amount of the Higher Education Benefit is shown in the Coverage Features.

We will pay a Higher Education Benefit to your Child if all of the following requirements are met:

1. You die as a result of an accident for which an AD&D Insurance Benefit is payable for Loss of your life.

2. Your Child is, within 12 months after the date of your death registered and in full-time attendance at an accredited institution of higher education beyond high school.

The Higher Education Benefit will be paid annually to each Child who meets the requirements of item 2 above, for a maximum of 4 consecutive years beginning on the date of your death. No Higher Education Benefit will be paid if there is no Child eligible to receive it.

Line Of Duty Benefit
The amount of the Line Of Duty Benefit is shown in the Coverage Features.

We will pay a Line Of Duty Benefit if all of the following requirements are met:

1. You are a Public Safety Officer.

2. You suffer a Loss for which an AD&D Insurance Benefit is payable.

3. The Loss is the result of a Line Of Duty Accident.

Public Safety Officer means a Member whose primary job duties include controlling or reducing crime or juvenile delinquency, criminal law enforcement, or fire suppression.

Public Safety Officer includes any one or more of the following: police officers, firefighters, corrections officers, judicial officers, and officially recognized or designated volunteer firefighters, if they otherwise meet the definition of Public Safety Officer. 9/2026 18 764999
Line of Duty Accident means an accident, including accidental exposure to adverse weather conditions, that occurs while you are taking any action which by rule, regulation, law, or condition of employment you are obligated or authorized to perform as a Public Safety Officer, in the course of controlling or reducing crime, criminal law enforcement, or fire suppression, including such action taken in response to an emergency while off duty.

If you are a Public Safety Officer, whose primary job duties are controlling or reducing crime, criminal law enforcement, or fire suppression, Line of Duty Accident includes a Line Of Duty Accident that occurs while you are any one or more of the following: on duty at social, ceremonial, or athletic functions to which you are assigned or for which you are paid as a Public Safety Officer by your Employer, or going directly to, attending, or returning directly from meetings or conventions associated with your profession.

Public Transportation Benefit
The amount of the Public Transportation Benefit is shown in the Coverage Features.

We will pay a Public Transportation Benefit if all of the following requirements are met:

1. You die as a result of an accident for which an AD&D Insurance Benefit is payable for Loss of your life.

2. The accident occurs while you are riding as a fare-paying passenger on Public Transportation.

Public Transportation means a public passenger conveyance operated by a licensed common carrier for the transportation of the general public for a fare and operating on regular passenger routes with a definite schedule of departures and arrivals.

Seat Belt Benefit
The amount of the Seat Belt Benefit is shown in the Coverage Features.

We will pay a Seat Belt Benefit if all of the following requirements are met:

1. You die as a result of an Automobile accident for which an AD&D Insurance Benefit is payable for Loss of your life.

2. The deceased is wearing and properly utilizing a Seat Belt System at the time of the accident, as evidenced by Proof Of Loss satisfactory to us.

Seat Belt System means a properly installed combination lap and shoulder restraint system that meets the Federal Vehicle Safety Standards of the National Highway Traffic Safety Administration.

Seat Belt System will include a lap belt alone, but only if the Automobile did not have a combination lap and shoulder restraint system when manufactured. Seat Belt System does not include a shoulder restraint alone.

Automobile means a motor vehicle licensed for use on public highways.

H. When AD&D Insurance Ends
AD&D Insurance for you ends automatically on the earliest of:

1. The date your Life Insurance ends.

2. The date your Waiver Of Premium begins.

3. The date AD&D Insurance terminates under the Group Policy.

4. The date the last period ends for which a premium was paid for your AD&D Insurance.

5. The last day for which premium contributions have been paid following your Written request to terminate your AD&D Insurance for you
LI.AD.OT.1
9/2026 19 764999

ACTIVE WORK PROVISIONS
If you are incapable of Active Work because of Sickness, Injury or Pregnancy on the day before the scheduled effective date of your insurance or an increase in your insurance, your insurance or increase will not become effective until the day after you complete one full day of Active Work as an eligible Member.

Active Work and Actively At Work mean actively at work for your Employer and performing with reasonable continuity the Material Duties of your Own Occupation at your usual place of business, for your Employer.

You will be deemed to be Actively At Work if all of the following requirements are met:

1. You were absent from Active Work because of a regularly scheduled day off, holiday, or vacation day.

2. You were Actively At Work on your last scheduled work day before the date of your absence.

3. You were capable of Active Work on the day before the scheduled effective date of your insurance or increase in your insurance.

Own Occupation means any employment, business, trade, profession, calling or vocation that involves Material Duties of the same general character as the occupation you are regularly performing for your Employer. In determining your Own Occupation, we are not limited to looking at the way you perform your job for your Employer, but may also look at the way the occupation is generally performed in the national economy.

Material Duties means the essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation that cannot be reasonably modified or omitted.

LI.AW.OT.1

CONTINUITY OF COVERAGE
A. Waiver Of Active Work Requirement
If you were insured under the Prior Plan on the day before the effective date of your Employer’s coverage under the Group Policy, you can become insured on the effective date of your Employer’s coverage without meeting the Active Work requirement. See Active Work Provisions.

B. Payment Of Benefit
The benefits payable for your death or dismemberment before you meet the Active Work requirement will be:

1. The benefits which would have been payable under the terms of the Prior Plan if it had remained in force; reduced by

2. Any benefits payable under the Prior Plan.

LI.CC.OT.1

PORTABILITY OF INSURANCE
A. Portability Of Insurance

1. You may be eligible to buy portable group insurance coverage as shown in the Coverage Features for yourself and your Dependents without submitting Evidence Of Insurability if your insurance under the Group Policy ends because of one of the following Portable Events.

Portable Event means any of the following:
a. Your employment with your Employer terminates.
b. Your employment with your Employer terminates due to termination of the Group Policy because the Policyholder or your Employer goes out of business. 9/2026 20 764999
c. You retire under the Employer’s retirement plan.

2. To be eligible, you must satisfy all of the following requirements:
a. On the date of your Portable Event, you must be able to perform with reasonably continuity the material duties of at least one gainful occupation for which you are reasonably fitted by education, training and experience.

If you are unable to meet this requirement, see the Right To Convert and Waiver Of Premium provisions for other options that may be available to you under the Group Policy. b. On the date of your Portable Event, you are under age 75. c. On the date of your Portable Event, you have been continuously insured under the Group Policy for at least 12 consecutive months. In computing the 12 consecutive month period, we will include time you were insured under the Prior Plan.
d. You must apply in Writing and pay the first premium directly to us within 31 days after the date of your Portable Event. You must purchase portable group life insurance coverage for yourself in order to purchase any other insurance eligible for portability.

This portable group insurance will be provided under a master Group Life Portability Insurance Policy we have issued to the Standard Insurance Company Group Insurance Trust. If approved, the certificate you will receive will be governed under the terms of the Group Life Portability Insurance Policy and will contain provisions that differ from your Employer’s coverage under the Group Policy.

B. Amount Of Portable Insurance
You may be eligible to buy the amount of your Insurance that is ending subject to the minimum and maximum amounts of Insurance eligible for portability as shown in the Coverage Features. If you retire under your Employer’s retirement plan, the maximum amount of Insurance you may continue under this provision is reduced by the amount of Life Insurance you retain as a retired Member under the Group Policy. You may buy less than the maximum amounts in increments of $1,000.

The combined amounts of insurance purchased under this Portability Of Insurance provision and the Right To Convert provision cannot exceed the amount in effect under the Group Policy on the day before your Portable Event.

C. When Portable Insurance Becomes Effective
If you apply within 31 days after the date of your Portable Event, and are otherwise eligible, then Portable group insurance will become effective on the date after your Portable Event.

D. Death During The Portable Event Period
If death occurs within 31 days after the date of your Portable Event, life insurance benefits, if any, will be paid according to the terms of the Group Policy in effect on the date of your Portable Event, and not the terms of the Group Life Portability Insurance Policy. If an Accidental Death And Dismemberment Loss occurs within 31 days after the date of your Portable Event, Accidental Death And Dismemberment benefits will be paid according to the AD&D Benefit Amount in effect under the Group Policy on the day before your Portable Event, not to exceed the maximum Portability amount as shown in the Coverage Features, provided you meet the requirements as stated in item 2 above. In no event will the benefits paid exceed the amount in effect under the Group Policy on the day before your Portable Event.

If you apply for portable group insurance, and death occurs during the Portable Event Period, and if you name a Beneficiary in your application that is different from the last Beneficiary you named under the Group Policy, then it will be considered a change of Beneficiary to the person named in the application. The change will take effect on the date of the application.

LI.TGP.OT.1
9/2026 21 764999

STRIKE CONTINUATION
Insurance may be continued for up to 6 months while you are absent from Active Work because of a strike, lockout, or other general work stoppage caused by a labor dispute. Rules 1 through 4 below will apply.

1. When your compensation is suspended or terminated because of a work stoppage, your Employer will immediately notify you in writing of your rights under this provision. Your Employer will mail the notice to you at your last address on record with the Employer.

2. You must pay the entire premium for your insurance, including the Employer’s share, if any, to your employer on or before each Premium Due Date.

3. The premiums for your insurance during the work stoppage will equal a percentage of the premium rate in effect on the date the work stoppage began (see Coverage Features). We may change premium rates during the work stoppage according to the terms of the Group Policy.

4. Insurance continued under this provision will end on the earliest of:
a. Any Premium Due Date if you fail to make the required premium contribution to your Employer on or before that date.
b. The date you have been absent from Active Work for 6 months. c. On the date you begin full-time employment with another employer. d. At our option, on any Premium Due Date if less than 75% of the Members eligible to continue insurance under this provision make the required premium payment to the Employer.

LI.RC.CA.1

WAIVER OF PREMIUM
A. Waiver Of Premium Benefit
Subject to When Waiver Of Premium Ends below, payment of premium for your Insurance will be waived while you are Totally Disabled if all of the following requirements are met:

1. You become Totally Disabled while insured under the Group Policy and under age 60.

2. You complete your Waiting Period.

3. You give Proof Of Loss satisfactory to us.

We may have you examined at our expense at reasonable intervals. Any such examination will be conducted by specialists of our choice.

B. Definitions For Waiver Of Premium

1. Insurance means all your insurance under the Group Policy, except AD&D Insurance.

2. Totally Disabled means that:
a. During the first 24 months: as a result of Sickness or bodily injury you are unable to perform with reasonable continuity the substantial and material duties of the job you were regularly performing for your Employer when Total Disability begins. b. Thereafter: as a result of Sickness or bodily Injury you are unable to perform with reasonable continuity any other job in which you could reasonably be expected to perform satisfactorily in light of your age, education, training, experience, station in life, or physical or mental capacity.

3. Waiting Period means:

The 180 consecutive day period beginning on the date you become Totally Disabled. Waiver Of Premium begins when you complete the Waiting Period.

C. Premium Payment
9/2026 22 764999
Premium payment must continue until the later of:

1. The date you complete your Waiting Period.

2. The date we approve your claim for Waiver Of Premium.

We will refund up to 12 months of the premiums that were paid for Insurance after the date you become Totally Disabled.

You may be eligible to buy an individual policy of life insurance if your Insurance under the Group Policy ends due to termination of your employment with your Employer during the Waiting Period. See Right To Convert.

If you exercise your Right To Convert during the Waiting Period, you will not be eligible for Waiver Of Premium unless you first surrender to us the converted individual policy of life insurance. The premiums paid for the converted individual policy of life insurance will be refunded. In no event will we pay a benefit for Insurance under both the Group Policy and the individual policy of life insurance purchased under Right To Convert.

D. Amount Of Insurance
The amount of Insurance eligible for Waiver Of Premium is the amount in effect on the day before you become Totally Disabled. However, the following will apply:

1. If you become Totally Disabled, Insurance will be reduced or terminated according to the Group Policy provisions in effect on the day before you become Totally Disabled.

2. If you become insured under a group life insurance plan that replaces the Group Policy while you are eligible for Waiver Of Premium, any death benefit payable under the Group Policy will be reduced by the amount payable under the replacement group life insurance plan.

3. If you receive an Accelerated Death Benefit, Insurance will be reduced according to the Accelerated Death Benefit provision. Insurance will be terminated according to the Group Policy provisions in effect on the day before you receive the Accelerated Death Benefit.

E. Effect Of Death During The Waiting Period
If you die during the Waiting Period and are otherwise eligible for Waiver Of Premium, the Waiting Period will be waived and Insurance will be payable according to the terms of the Group Policy.

F. Termination Or Amendment Of The Group Policy
Insurance will not be affected by termination or amendment of the Group Policy after you become Totally Disabled.

G. When Waiver Of Premium Ends
Waiver of Premium ends on the earliest of:

1. The date you cease to be Totally Disabled.

2. 90 days after the date we mail you a request for additional Proof Of Loss, if it is not given.

3. The date you fail to attend an examination or cooperate with the examiner.

4. With respect to the amount of Insurance which an insured has converted, the effective date of the individual life insurance policy issued to the insured.

5. The date you reach age 65.

H. Notice Of Right To Convert
If Insurance continued under Waiver Of Premium ends or is reduced, you may be eligible to buy an individual policy of life insurance under Right To Convert.

LI.WP.CA.1
9/2026 23 764999

ACCELERATED DEATH BENEFIT
A. Accelerated Death Benefit
If you give us satisfactory proof of having a Qualifying Medical Condition while you are insured under the Group Policy, you may have the right to receive during your lifetime a portion of your Insurance as an Accelerated Death Benefit. You must have at least $10,000 of Insurance in effect to be eligible.

Qualifying Medical Condition means you are terminally ill as a result of an illness or physical condition which is reasonably expected to result in death within 12 months.

We may have you examined at our expense in connection with your claim for an Accelerated Death Benefit. Any such examination will be conducted by one or more Physicians of our choice.

B. Application For Accelerated Death Benefit
You must apply for an Accelerated Death Benefit. To apply you must give Proof Of Loss satisfactory to us on our forms. Proof Of Loss must include a statement from a Physician that you have a Qualifying Medical Condition.

C. Amount Of Accelerated Death Benefit
You may receive an Accelerated Death Benefit of up to 80% of your Life Insurance. The maximum Accelerated Death Benefit is $500,000. The minimum Accelerated Death Benefit is $5,000 or 10% of your Insurance, whichever is greater.

If the amount of your Insurance is scheduled to reduce within 12 months following the date you apply for the Accelerated Death Benefit, your Accelerated Death Benefit will be based on the reduced amount.

The Accelerated Death Benefit will be paid to you once in your lifetime in a lump sum. If you recover from your Qualifying Medical Condition after receiving an Accelerated Death Benefit, we will not ask you for a refund.

D. Effect On Insurance And Other Benefits
For any purpose other than premium payment, the amount of your Insurance after payment of the Accelerated Death Benefit will be the amount of your Insurance as if no Accelerated Death Benefit had been paid; minus the amount of the Accelerated Death Benefit.

Your AD&D Insurance, if any, is not affected by payment of the Accelerated Death Benefit.

E. Payment Of Premium
If you qualify for Waiver Of Premium, no premium payment is required. Otherwise premiums will be based on the amount of your Insurance in effect before payment of the Accelerated Death Benefit and premium payment must be continued based on the full amount of your Insurance after the payment of the Accelerated Death Benefit.

F. Exclusions
No Accelerated Death Benefit will be paid if any of the following apply:

1. All or part of your Insurance must be paid to your child, or your Spouse or former Spouse as part of a court approved divorce decree, separate maintenance agreement, or property settlement agreement.

2. You are married and live in a community property state, unless you give us a Signed Written consent from your Spouse.

3. You have made an assignment of your Insurance, unless you give us a Signed Written consent from the assignee.

4. You have filed for bankruptcy, unless you give us Written approval from the Bankruptcy Court for payment of the Accelerated Death Benefit.
9/2026 24 764999

5. You are required by a government agency to use the Accelerated Death Benefit to apply for, receive, or continue a government benefit or entitlement.

6. You have previously received an Accelerated Death Benefit under the Group Policy.

G. Definitions For Accelerated Death Benefit
Insurance means your insurance under the Group Policy identified in the Other Provisions section of the Coverage Features as eligible for the Accelerated Death Benefit.

You and your mean the Member.

LI.ADB.OT.1

RIGHT TO CONVERT
A. Right To Convert
You and your Dependents may buy an individual policy of life insurance without Evidence Of Insurability if all of the following requirements are met:

1. Your or your Dependents Insurance ends or is reduced due to a Qualifying Event.

2. You or your Dependents apply in Writing and pay us the first premium during the Conversion Period.

The maximum amount you and your Dependents have a Right To Convert is the amount of your Insurance which ended, except as limited under C. Limits On Right To Convert.

B. Definitions For Right To Convert

1. Conversion Period means the 31-day period after the date of any Qualifying Event.

2. Insurance means your Life Insurance and your Dependent Life Insurance under the Group Policy, excluding AD&D Insurance.

3. Qualifying Event means termination or reduction of your or your Dependents' Insurance for any reason except:
a. The Member’s failure to make a required premium contribution. b. Payment of an Accelerated Death Benefit.

C. Limits On Right To Convert
If your or your Dependents' Insurance ends or is reduced because of termination or amendment of the Group Policy, the following will apply.

1. You and your Dependents may not convert Insurance which has been in effect for less than 5 years.

2. The maximum amount that may be converted is the lesser of:
a. The amount of Insurance which ended, minus any other group life insurance for which you and your Dependents become eligible during the Conversion Period. b. $2,000.

D. The Individual Policy
You and your Dependents may select an individual whole life insurance policy we issue to persons of your or your Dependents age, except:

1. A policy with disability, accidental death, or other additional benefits.

2. A policy in an amount less than the minimum amount we issue. 9/2026 25 764999
The individual policy of life insurance will become effective on the day after the end of the Conversion Period. We will use our published rates for standard risks to determine the premium.

E. Death During The Conversion Period
If you or your Dependents die during the Conversion Period, we will pay a death benefit equal to the maximum amount you or your Dependents had a Right To Convert, whether or not you or your Dependents applied for an individual policy. In no event will the benefits paid exceed the amount in effect under the Group Policy on the day before your or your Dependent's Qualifying Event.

If you or your Spouse apply for an individual policy of life insurance, and death occurs during the Right To Convert Period, and if you or your Spouse name a Beneficiary in your or your Spouse's application that is different from the last Beneficiary you or your Spouse named under the Group Policy, then it will be considered a change of Beneficiary to the person named in the application. The change will take effect on the date of the application.

LI.RC.OT.1
CLAIMS
A. Filing A Claim
Claims should be filed on our forms. If we do not provide our forms within 15 days after they are requested, the claim may be submitted in a letter to us.

For Waiver Of Premium and Accelerated Death Benefit, the letter should include the character and the extent of the occurrence or loss which are being claimed, as required in item C. Proof Of Loss.

Subject to the time period in item B. Time Limits On Filing Proof Of Loss, such letter will constitute notice.

B. Time Limits On Filing Proof Of Loss
Proof Of Loss must be provided within 90 days after the date of the loss. If that is not possible, it must be provided as soon as reasonably possible, but not later than one year after the 90-day period.

With respect to coma, we will require Proof Of Loss of the comatose condition at reasonable intervals.

If proof is not given within 90 days, benefits payable for coma will end.

If Proof Of Loss is filed outside these time limits, the claim will be denied. These limits will not apply while the Member or Beneficiary lacks legal capacity.

C. Proof Of Loss
Proof Of Loss means Written proof that a loss occurred:

1. For which the Group Policy provides benefits;

2. Which is not subject to any exclusions; and

3. Which meets all other conditions for benefits.

Proof Of Loss includes any other information we may reasonably require in support of a claim. Proof Of Loss must be in Writing and must be provided at the expense of the claimant.

D. Time Limits On Filing Proof Of Loss For Waiver Of Premium Proof Of Loss for Waiver Of Premium must be provided within 12 months after the end of the Waiting Period. Failure to furnish Proof Of Loss will not invalidate or reduce any claim if it can be shown that it was not reasonably possible to furnish such Proof Of Loss, provide it is furnished as soon as reasonably possible.

Proof Of Loss is provided outside the 12 month time limit noted above, the claim may be denied. This limit will not apply while the Member or Beneficiary lacks legal capacity. 9/2026 26 764999
We will require further Proof Of Loss at reasonable intervals, but not more often than once a year after you have been continuously Totally Disabled for two years.

E. Time Limits On Filing Proof Of Loss For Accelerated Death Benefit With respect to Accelerated Death Benefit, we will require Proof Of Loss of your Qualifying Medical Condition. If Proof Of Loss of the Qualifying Medical Condition is not provided, the claim may be denied.

F. Investigation Of Claim
We may have you examined at our expense at reasonable intervals. Any such examination will be conducted by specialists of our choice.

We may have an autopsy performed at our expense, except where prohibited by law.

G. Time Of Payment
We will pay benefits within 60 days after the latest date shown below:

1. The date Proof Of Loss is satisfied.

2. The date we receive sufficient information to determine liability, the extent of liability and the appropriate payee legally entitled to benefits.

3. The date that legal impediments to payment of benefits that depend on the action of parties other than us are resolved and sufficient evidence of resolution is provided to us. Legal impediments to payment include, but are not limited to:
a. The establishment of guardianships or conservatorships. b. The appointment and qualification of trustees, executors and administrators. c. The submission of information required to satisfy state or federal reporting requirements.

Interest, if applicable, will accrue 30 days from the latest of the dates shown above, continuing up to the date of payment.

Payment made in good faith shall discharge us of liability to the extent of such payment.

H. Notice Of Decision On Claim
We will evaluate a claim for benefits promptly after we receive it. With respect to all claims except Waiver Of Premium claims, within 90 days after we receive the claim we will send the claimant: (a) a Written decision on the claim; or (b) a notice that we are extending the period to decide the claim for an additional 90 days.

With respect to Waiver Of Premium claims, within 45 days after we receive the claim we will send the claimant: (a) a Written decision on the Waiver Of Premium claim; or (b) a notice that we are extending the period to decide the claim for 30 days. Before the end of this extension period we will send the claimant: (a) a Written decision on the Waiver Of Premium claim; or (b) a notice that we are extending the period to decide the claim for an additional 30 days. If an extension is due to the claimant's failure to provide information necessary to decide the Waiver Of Premium claim, the extended time period for deciding the claim will not begin until the claimant provides the information or otherwise responds.

If we extend the period to decide the claim, we will notify the claimant of the following: (a) the reasons for the extension; (b) when we expect to decide the claim; (c) an explanation of the standards on which entitlement to benefits is based; (d) the unresolved issues preventing a decision; and (e) any additional information we need to resolve those issues.

If we request additional information, the claimant will have 45 days to provide the information. If the claimant does not provide the requested information within 45 days, we may decide the claim based on the information we have received.

If we deny any part of the claim, we will send the claimant a Written notice of denial containing the following:
9/2026 27 764999

1. The reasons for our decision.

2. Reference to the parts of the Group Policy on which our decision is based.

3. A copy of any internal rule or guideline relied upon in making our Waiver Of Premium decision, or a statement that no such rules or guidelines exist.

4. A description of any additional information needed to support the claim.

5. Information concerning the claimant’s right to receive, free of charge, copies of non-privileged documents and records relevant to the claim.

6. Information concerning the claimant's right to a review of our decision.

I. Review Procedure
If all or part of a claim is denied, the claimant may request a review. The claimant must request a review in Writing:

1. Within 180 days after receiving notice of the denial of a claim for Waiver Of Premium.

2. Within 60 days after receiving notice of the denial of any other claim.

The claimant may send us Written comments or other items to support the claim. The claimant may review and receive copies of any non-privileged information that is relevant to the request for review.

There will be no charge for such copies. Our review will include any Written comments or other items the claimant submits to support the claim.

We will review the claim promptly after we receive the request. With respect to all claims except Waiver Of Premium claims, within 60 days after we receive the request for review we will send the claimant:
(a) a Written decision on review; or (b) a notice that we are extending the review period for 60 days.

With respect to Waiver Of Premium claims, within 45 days after we receive the request for review we will send the claimant: (a) a Written decision on review; or (b) a notice that we are extending the review period for 45 days.

If an extension is due to the claimant's failure to provide information necessary to decide the claim on review, the extended time period for review of the claim will not begin until the claimant provides the information or otherwise responds.

If we extend the review period, we will notify the claimant of the following: (a) the reasons for the extension; (b) when we expect to decide the claim on review; and (c) any additional information we need to decide the claim.

If we request additional information, the claimant will have 45 days to provide the information. If the claimant does not provide the requested information within 45 days, we may conclude our review of the claim based on the information we have received.

With respect to Waiver Of Premium claims, the person conducting the review will be someone other than the person who denied the claim and will not be subordinate to that person. The person conducting the review will not give deference to the initial denial decision. If the denial was based on a medical judgement, the person conducting the review will consult with a qualified health care professional. This health care professional will be someone other than the person who made the original medical judgement and will not be subordinate to that person. The claimant may request the names of medical or vocational experts who provided advice to us about a claim for Waiver Of Premium.

If we deny any part of the claim on review, the claimant will receive a Written notice of denial containing the following:

1. The reasons for our decision.

2. Reference to the parts of the Group Policy on which our decision is based.

3. A copy of any internal rule or guideline relied upon in making our Waiver Of Premium decision, or a statement that no such rules or guidelines exist.
9/2026 28 764999

4. Information concerning the claimant’s right to receive, free of charge, copies of non-privileged documents and records relevant to the claim.

LI.CL.CA.1

ASSIGNMENT
The rights and benefits under the Group Policy cannot be assigned.

LI.AS.OT.1

BENEFIT PAYMENT AND BENEFICIARY PROVISIONS
A. Payment Of Benefits

1. Except as provided in item 5 below, benefits payable because of your death will be paid to the Beneficiary you named. Benefits payable because of coma will be paid to the Beneficiary you name.

See B through E of this section.

2. AD&D Insurance Benefits payable for Losses other than Loss of Life or coma will be paid to the person who suffers the Loss for which the benefits are payable. Any such benefits remaining unpaid at that person's death will be paid according to the provisions for payment of a death benefit.

3. The benefits below will be paid to you if you are living:
a. Spouse and Child Life Insurance Benefits.
b. Accelerated Death Benefit.

4. Spouse and Child Life Insurance Benefits payable to you because of the death of your Dependent which were unpaid at your death will be paid in equal shares to the first surviving class of the classes below.
a. The children of the Dependent.
b. The parents of the Dependent.
c. The brothers and sisters of the Dependent.
d. Your estate.

5. Additional Benefits will be paid as follows:

The Child Care Benefit will be paid to your surviving Spouse. No Child Care Benefit will be paid if you have no Spouse.

The Career Adjustment Benefit will be paid to your surviving Spouse. No Career Adjustment Benefit will be paid if you have no Spouse.

The Higher Education Benefit will be paid annually to each eligible Child. No Higher Education Benefit will be paid if there is no Child eligible to receive it.

The Repatriation Benefit will be paid to the person who incurs the transportation expenses.

B. Naming A Beneficiary
Beneficiary means a person you name to receive your death benefits. You may name one or more Beneficiaries.

If you name two or more Beneficiaries in a class:

1. Two or more surviving Beneficiaries will share equally, unless you provide for unequal shares.

2. If you provide for unequal shares in a class, and two or more Beneficiaries in that class survive, we will pay each surviving Beneficiary his or her designated share. Unless you provided otherwise, we will then pay the share(s) otherwise due to any deceased Beneficiary(ies) to the surviving Beneficiaries pro rata based on the relationship that the designated percentage or 9/2026 29 764999
fractional share of each surviving Beneficiary bears to the total shares of all surviving Beneficiaries.

3. If only one Beneficiary in a class survives, we will pay the total death benefits to that Beneficiary.

You may name or change Beneficiaries at any time without the consent of a Beneficiary.

Your Beneficiary designations must be the same for Life Insurance and AD&D Insurance death benefits.

Your designation must meet all of the following requirements:

1. You must name or change Beneficiaries in Writing. Writing includes a form Signed by you or a verification from us or our designated agent, the Policyholder or the Policyholder’s designated agent, or the Employer or the Employer’s designated agent of an electronic or telephonic designation made by you.

2. Must be dated.

3. Must be delivered to us or our designated agent, the Policyholder or the Policyholder’s designated agent, or the Employer or the Employer’s designated agent, during your lifetime.

4. Must relate to the insurance provided under the Group Policy.

Your designation will take effect on the date it is received by us or our designated agent, the Policyholder or the Policyholder’s designated agent, or the Employer or the Employer’s designated agent.

If we approve it, a designation which meets the requirements of a Prior Plan will be accepted as your Beneficiary designation under the Group Policy.

C. Simultaneous Death Provision
If a Beneficiary or a person in one of the classes listed in item D. No Surviving Beneficiary dies on the same day you die, or within 15 days thereafter, benefits will be paid as if that Beneficiary or person had died before you, unless Proof Of Loss with respect to your or your Spouse's death is delivered to us before the date of the Beneficiary's death.

D. No Surviving Beneficiary
If you do not name a Beneficiary or if you are not survived by one, benefits will be paid in equal shares to the first surviving class of the classes below.

1. Your spouse/Spouse.

2. Your children.

3. Your parents.

4. Your brothers and sisters.

5. Your estate.

E. Method Of Payment
Recipient means a person who is entitled to benefits under this Benefit Payment and Beneficiary Provisions section.

1. Lump Sum
If the amount payable to a Recipient is less than $25,000, we will pay it in a lump sum. 9/2026 30 764999

2. Standard Secure Access Checking Account
If the amount payable to a Recipient is $25,000 or more, we will deposit it into a Standard Secure Access checking account which:
a. Bears interest at a rate equal to the 13-week Treasury Bill (T-Bill) auction rate, but not to exceed 5%.
b. Is owned by the Recipient.
c. Is subject to the terms and conditions of a confirmation certificate which will be given to the Recipient.
d. Is fully guaranteed by us.

To the extent permitted by law, the amount payable to the Recipient will not be subject to any legal process or to the claims of any creditor or creditor's representative.

LI.BB.OT.1

RIGHT TO RECOVERY
If benefits have been overpaid on any claim then full reimbursement to us is required within 60 days of notification to you, your Beneficiary or your estate. If reimbursement is not made then we have the right to do any of the following:

1. Reduce future benefits until full reimbursement is made.

2. Recover such overpayments from you, your Beneficiary or your estate.

Such reimbursement is required whether the overpayment is due to fraud, our error in processing a claim or any other reason.

LI.RR.OT.1

CLAIMANT COOPERATION
If you or your Beneficiary fails to cooperate with us in the administration of your claim, we may close or deny the claim. Such cooperation includes, but is not limited to, providing any information or documentation needed to determine if benefits are payable or the actual benefit amount due.

LI.CLC.OT.1

AGENCY, RELEASE AND INDEMNIFICATION
Individuals selected by the Policyholder or by any Employer to secure coverage under the Group Policy or to perform their administrative function under it, represent and act on behalf of the person selecting them, and do not represent or act on behalf of Standard Insurance Company. The Policyholder, Employer and such individuals have no authority to alter, expand or extend our liability or to waive, modify or compromise any defense or right we may have under the Group Policy. The Policyholder and each Employer hereby release, hold harmless and indemnify Standard Insurance Company from any liability arising from or related to any negligence, error, omission, misrepresentation or dishonesty of any of them or their representatives, agency or employees.

LI.AR.OT.1

TIME LIMITS ON LEGAL ACTIONS
No action at law or in equity may be brought until 60 days after we have been given Proof Of Loss. No such action may be brought more than three years after the adverse decision date.

LI.TL.OT.1
9/2026 31 764999

INCONTESTABILITY OF INSURANCE
Any statement made to obtain or to increase insurance is, in the absence of fraud, a representation and not a warranty.

No misrepresentation will be used to reduce or deny a claim unless all of the following requirements are met:

1. The insurance would not have been approved for you, your Spouse or your Child if we had known the truth.

2. We have given you or any other person claiming benefits a copy of the Signed Written instrument which contains the misrepresentation.

We will not use a misrepresentation to reduce or deny a claim after your, your Spouse's or your Child's insurance has been in effect for two years during the lifetime of the insured, your Spouse or your Child.

LI.IN.OT.1

CLERICAL ERROR, MISSTATEMENT AND AGENCY
A. Clerical Error And Agency
Clerical error by us, the Policyholder, your Employer, or their respective employees or representatives will not:

1. Cause a person to become insured.

2. Invalidate insurance under the Group Policy otherwise validly in force.

3. Continue insurance under the Group Policy otherwise validly terminated.

The Policyholder and your Employer act on their own behalf as your agent, and not as our agent. The Policyholder and your Employer have no authority to alter, expand or extend our liability or to waive, modify or compromise any defense or right we may have under the Group Policy.

B. Misstatement Of Age
If a person's age has been misstated, we will make an equitable adjustment of premiums, benefits, or both. The adjustment will be based on:

1. The amount of insurance based on the correct age.

2. The difference between the premiums paid and the premiums which would have been paid if the age had been correctly stated.

LI.CE.OT.1

DEFINITIONS
AD&D Insurance means accidental death and dismemberment insurance, if any under the Group Policy.

Annual Earnings means your annual rate of earnings from your Employer. Your Annual Earnings will be based on your earnings in effect on your last full day of Active Work.

Annual Earnings includes:

1. Contributions you make through a salary reduction agreement with your Employer to:
a. An Internal Revenue Code (IRC) Section 401(k), 403(b), 408(k), or 457 deferred compensation arrangement; or
b. An executive nonqualified deferred compensation arrangement.

2. Amounts contributed to your fringe benefits according to a salary reduction agreement under an IRC Section 125 Plan.
9/2026 32 764999
Annual Earnings does not include:

1. Bonuses.

2. Commissions.

3. Overtime pay.

4. Stock options or stock bonuses.

5. Your Employer’s contributions on your behalf to any deferred compensation arrangement or pension plan.

6. Any other extra compensation.

Child means:

1. Your child from live birth through age 25.

2. Your disabled child who is 26 years of age or older, is your qualifying child as defined by the Internal Revenue Service for whom you or your Spouse claims as a dependent on Federal Income Taxes filed for the preceding calendar year and meets one of the following requirements:
a. Has been insured continuously under the Group Policy prior to reaching age 26. b. Who is 26 years of age or older at the time of your initial eligibility under the Group Policy.

3. Child includes any of the following, if they otherwise meet the definition of Child:
a. Your adopted child.
b. Your stepchild if living in your home.

Contributory means you pay all or part of the premium for insurance.

Dependent means your Spouse or Child.

Dependent Life Insurance means Dependent Life Insurance For Your Spouse and/or Dependent Life Insurance For Your Child, if any, under the Group Policy. It may also be referred to as Spouse Life Insurance Benefit and/or Child Life Insurance Benefit as applicable.

Eligibility Waiting Period means the period you must be a Member before you become eligible for insurance.

See Coverage Features.

Employer means an employer for which coverage under the Group Policy is approved in Writing by us. See Coverage Features.

Evidence Of Insurability means an applicant must do all of the following:

1. Complete and sign our medical history statement.

2. Sign our form authorizing us to obtain information about the applicant's health.

3. Undergo a physical examination, if required by us, which may include blood testing.

4. Provide any additional information about the applicant's insurability that we may reasonably require.

Group Policy means this group life insurance policy issued by us to the Policyholder and identified by the Group Policy Number, the Policyholder’s attached application, group life insurance Certificates with the same Group Policy Number, and any amendments to the Group Policy or Certificates.

Hospital means a legally operated hospital providing full-time medical care and treatment under the direction of a full-time staff of licensed Physicians.

Injury means an injury to the body.

Life Insurance means life insurance under the Group Policy.

Noncontributory means the Policyholder or Employer pays the entire premium for insurance. 9/2026 33 764999
Nursing Home means a licensed institution operated for the purpose of providing nursing care and treatment for individuals which provides 24-hour nursing services under the direction and supervision of a Physician.

Physician means a licensed M.D. or D.O., acting within the scope of the license. Physician does not include you or your Spouse, or the brother, sister, parent or child of either you or your Spouse.

Pregnancy means your pregnancy, childbirth, or related medical conditions, including complications of pregnancy.

Prior Plan means your Employer’s group life insurance plan in effect on the day before the effective date of your Employer’s coverage under the Group Policy and which is replaced by the Group Policy.

Sickness means your sickness, illness or disease.

Signed means any symbol or method executed or adopted by you with the present intention to authenticate a record, and which is on or transmitted by paper, electronic or telephonic media, and which is consistent with applicable law, and authorized or accepted by us.

Spouse means:

1. A person to whom you are legally married; or

2. Your Domestic Partner. Domestic Partner means an individual recognized as such under California state law.

However, for the purposes of insurance under the Group Policy, Spouse does not include a person who is a full-time member of the armed forces of any country or a person from whom you are divorced or legally separated.

Writing or Written means a record which is on or transmitted by paper, electronic or telephonic media, and which is consistent with applicable law, and authorized or accepted by us.

LI.DF.CA.1

NOTICE OF PROTECTION PROVIDED BY CALIFORNIA LIFE AND HEALTH

INSURANCE GUARANTEE ASSOCIATION
This notice provides a brief summary regarding the protections provided to policyholders by the California Life and Health Insurance Guarantee Association ("the Association").

The purpose of the Association is to assure that policyholders will be protected, within certain limits, in the unlikely event that a member insurer of the Association becomes financially unable to meet its obligations. Insurance companies licensed in California to sell life insurance, health insurance, annuities and structured settlement annuities are members of the Association. The protection provided by the Association is not unlimited and is not a substitute for consumers’ care in selecting insurers. This protection was created under California law, which determines who and what is covered and the amounts of coverage.

Below is a brief summary of the coverages, exclusions and limits provided by the Association. This summary does not cover all provisions of the law; nor does it in any way change anyone’s rights or obligations or the rights or obligations of the Association.

COVERAGE
 Persons Covered
Generally, an individual is covered by the Association if the insurer was a member of the Association and the individual lives in California at the time the insurer is determined by a court to be insolvent. Coverage is also provided to policy beneficiaries, payees or assignees, whether or not they live in California  Amounts of Coverage
The basic coverage protections provided by the Association are as follows.  Life Insurance, Annuities and Structured Settlement Annuities For life insurance policies, annuities and structured settlement annuities, the Association will provide the following:
 Life Insurance
80% of death benefits but not to exceed $300,000
80% of cash surrender or withdrawal values but not to exceed $100,000  Annuities and Structured Settlement Annuities
80% of the present value of annuity benefits, including net cash withdrawal and net cash surrender values but not to exceed $250,000 The maximum amount of protection provided by the Association to an individual, for all life insurance, annuities and structured settlement annuities is $300,000, regardless of the number of policies or contracts covering the individual.
 Health Insurance
The maximum amount of protection provided by the Association to an individual, as of July 1, 2016, is $546,741. This amount will increase or decrease based upon changes in the health care cost component of the consumer price index to the date on which an insurer becomes an insolvent insurer. Changes to this amount will be posted on the Association’s website www.califega.org.

COVERAGE LIMITATIONS AND EXCLUSIONS FROM COVERAGE
The Association may not provide coverage for this policy. Coverage by the Association generally requires residency in California. You should not rely on coverage by the Association in selecting an insurance company or in selecting an insurance policy.

The following policies and persons are among those that are excluded from Association coverage:
 A policy or contract issued by an insurer that was not authorized to do business in California when it issued the policy or contract
 A policy issued by a health care service plan (HMO), a hospital or medical service organization, a charitable organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company, an insurance exchange, or a grants and annuities society
 If the person is provided coverage by the guaranty association of another state  Unallocated annuity contracts; that is, contracts which are not issued to and owned by an individual and which do not guaranty annuity benefits to an individual  Employer and association plans, to the extent they are self-funded or uninsured  A policy or contract providing any health care benefits under Medicare Part C or Part D
 An annuity issued by an organization that is only licensed to issue charitable gift annuities
 Any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as certain investment elements of a variable life insurance policy or a variable annuity contract  Any policy of reinsurance unless an assumption certificate was issued  Interest rate yields (including implied yields) that exceed limits that are specified in Insurance Code Section 1067.02(b)(2)(C).

NOTICES
Insurance companies or their agents are required by law to give or send you this notice.

Policyholders with additional questions should first contact their insurer or agent. To learn more about coverages provided by the Association, please visit the Association’s website at www.califega.org, or contact either of the following:

California Life and Health Insurance California Department of Insurance Guarantee Association Consumer Communications Bureau
PO Box 16860 300 South Spring Street
Beverly Hills, CA 90209-3319 Los Angeles CA 90013
(323) 782-0182 (800) 927-4357
Insurance companies and agents are not allowed by California law to use the existence of the Association or its coverage to solicit, induce or encourage you to purchase any form of insurance. When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between this notice and California law, then California law will control.

CALIFORNIA NOTICE OF COMPLAINT PROCEDURE
Should any dispute arise about your premium or about a claim that you have filed, write to the company that issued the group policy at:

Standard Insurance Company
PO Box 711
Portland, OR 97207
(503) 321-7000
If the problem is not resolved, you may also write to the State of California at:

Department of Insurance
Consumer Services Division
300 S. Spring Street, 9th FL
Los Angeles, CA 90013
1-800-927-HELP (4357)
www.insurance.ca.gov/0500-about-us/02-department/030-csmcb/consumerservices.cfm This notice of complaint procedure is for information only and does not become a part or condition of this group policy/certificate.

STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282
(503) 321-7000

GROUP LIFE INSURANCE POLICY
Policyholder: City Of Anaheim
Policy Number: 764999 [retirees]
Effective Date: January 1, 2027
The consideration for this Group Policy is the application of the Policyholder and the payment by the Policyholder of premiums as provided herein.

Subject to the Policyholder Provisions and the Incontestability Of Group Policy, this Group Policy (a) is issued for the Initial Rate Guarantee Period shown in the Coverage Features, and (b) may be renewed for successive renewal periods by the payment of the premium set by us on each renewal date. The length of each renewal period will be set by us, but will not be less than 12 months.

For purposes of effective dates and ending dates under this Group Policy, all days begin and end at 12:00 midnight Standard Time at the Policyholder's address.

This policy includes an Accelerated Death Benefit. Death benefits will be reduced if an Accelerated Death Benefit is paid. The receipt of this benefit may be taxable and may affect your eligibility for Medicaid or other government benefits or entitlements. However, if you meet the definition of “terminally ill individual” in Internal Revenue Code section 101, your Accelerated Death Benefit may be non-taxable. You should consult your personal tax and/or legal advisor before you apply for an Accelerated Death Benefit.

All provisions on this and the following pages are part of this Group Policy. Unless defined differently within a particular provision, the terms "you" and "your" mean the Member. "We", "us", and "our" mean Standard Insurance Company. Other defined terms appear with their initial letters capitalized. Section headings, and references to them, appear in bold face type.

STANDARD INSURANCE COMPANY
By
President and CEO Corporate Secretary
GP1219-LIFE

TABLE OF CONTENTS
COVERAGE FEATURES .............................................................................................................................. 1 PREMIUM RATES AND RENEWALS .................................................................................................... 1 GROUP POLICY ........................................................................................................................................... 2 INCONTESTABILITY OF GROUP POLICY ................................................................................................. 2 TERMINATION OR AMENDMENT OF THE GROUP POLICY .................................................................... 2 POLICYHOLDER PROVISIONS .................................................................................................................. 3 A. Premiums ........................................................................................................................................... 3 B. Contributions From Members ............................................................................................................. 3 C. Changes In Premium Rates ............................................................................................................... 3 D. Payment Of Premiums ....................................................................................................................... 3 E. Grace Period And Termination For Nonpayment ............................................................................... 3 F. Termination For Other Reasons ......................................................................................................... 3 G. Premium Adjustments ........................................................................................................................ 4 H. Certificates ......................................................................................................................................... 4 I. Records And Reports .......................................................................................................................... 4 J. Agency, Release And Indemnification ................................................................................................ 4 K. Notice Of Suit ..................................................................................................................................... 4 L. Entire Contract, Changes ................................................................................................................... 4 M. Effect On Workers' Compensation, State Disability Insurance ......................................................... 4 9/2026 1 764999

COVERAGE FEATURES

PREMIUM RATES AND RENEWALS
Premium Rates:

Premium Rates:

Life Insurance: $2.25 monthly per $1,000 of Life Insurance Premium Due Dates: January 1, 2027, and the first day of each calendar month thereafter.

Renewal Date: January 1
Grace Period: 60 days
Initial Rate Guarantee Period: January 1, 2027, to January 1, 2030 Notice of Rate Change: 180 days
Minimum Participation:

Life Insurance:

Number: 10 insured Members
Percentage: 25% of eligible Members
9/2026 2 764999

GROUP POLICY
Group Policy means the entire contract between the Policyholder and us. We will provide benefits according to the terms of the Group Policy. The Group Policy consists of the following:

1. This group life insurance policy issued by us to the Policyholder and identified by the Group Policy Number.

2. The Policyholder’s attached application.

3. Group life insurance Certificates with the same Group Policy Number.

4. Any amendments to the Group Policy or Certificates.

The Policyholder’s rights or the rights of any Member will only be affected by provisions that are part of the Group Policy. Only an executive of Standard Insurance Company may bind us by making a promise or a representation; or accept a representation that relates to the Group Policy.

LI.GP.OT.1

INCONTESTABILITY OF GROUP POLICY
Any statement made by the Policyholder to obtain the Group Policy or made by an Employer to obtain coverage under the Group Policy is, in the absence of fraud, a representation and not a warranty.

No misrepresentation by the Policyholder or your Employer will be used to deny a claim or to deny the validity of the Group Policy unless all of the following requirements are met:

1. The Group Policy would not have been issued if we had known the truth.

2. We have given the Policyholder or your Employer a copy of a Written instrument signed by the Policyholder or your Employer which contains the misrepresentation.

LI.IN.OT.1

TERMINATION OR AMENDMENT OF THE GROUP POLICY
The Group Policy may be terminated by us or the Policyholder according to its terms. It will terminate automatically for nonpayment of premium.

The Policyholder may terminate the Group Policy in whole, and may terminate insurance for any class or group of Members, at any time by giving us Written notice. The effective date of the termination will be the date stated in the notice. If no date is stated in the notice, then the effective date of termination will be the last day of the calendar month for which the premium was paid.

Benefits under the Group Policy are limited to its terms, including any valid amendment. No change or amendment will be valid unless it is approved in Writing by one of our executive officers and given to the Policyholder for attachment to the Group Policy. If the terms of the Certificate differ from the Group Policy, the terms stated in the Group Policy will govern. The Policyholder, your Employer, and their respective employees or representatives have no right or authority to change or amend the Group Policy or to waive any of its terms or provisions without our signed, Written approval.

We may change the Group Policy in whole or in part when any change or clarification in law or governmental regulation affects our obligations under the Group Policy, or with the Policyholder's written consent.

Any such change or amendment of the Group Policy may apply to current or future Members or to any separate classes or groups of Members.

LI.TA.OT.1
9/2026 3 764999

POLICYHOLDER PROVISIONS
A. Premiums
The premium due on each Premium Due Date is the sum of the premiums for all persons then insured.

Premium Rates are shown in the Coverage Features.

B. Contributions From Members
The Policyholder determines the amount, if any, of each Member's contribution toward the cost of insurance.

C. Changes In Premium Rates
We may change Premium Rates at any time when:

1. A change or clarification in law or governmental regulation affects the amount payable under the Group Policy. Any such change in Premium Rates will reflect only the change in our obligations.

2. Factors material to underwriting the risk we assumed under the Group Policy, including, but not limited to, number of persons insured, age, Annual Earnings, gender and occupational classification, change by 25% or more.

3. We and the Policyholder mutually agree in writing to change Premium Rates.

Except as provided above, Premium Rates will not be changed during the Initial Rate Guarantee Period shown in the Coverage Features.

Thereafter, except as provided above, we may change Premium Rates upon advance Written notice to the Policyholder. The minimum advance notice is shown in the Coverage Features as Notice of Rate Change. Any such change in Premium Rates may be made effective on any Premium Due Date, but no such change will be made more than once in any contract year. Contract years are successive 12 month periods computed from the end of the Initial Rate Guarantee Period.

D. Payment Of Premiums
All premiums are due on the Premium Due Date shown in the Coverage Features.

Each premium is payable on or before its Premium Due Date directly to us. The payment of each premium by the Policyholder as it becomes due will maintain the Group Policy in force until the next Premium Due Date.

E. Grace Period And Termination For Nonpayment
If a premium is not paid on or before its Premium Due Date, it may be paid during the following Grace Period. The length of the Grace Period is shown in the Coverage Features. The Group Policy will remain in force during the Grace Period.

If the premium is not paid during the Grace Period, the Group Policy will terminate automatically at the end of the Grace Period.

The Policyholder is liable for premium during the Grace Period. We may charge interest at the legal rate for any premium which is not paid during the Grace Period, beginning with the first day after the Grace Period.

F. Termination For Other Reasons
The Policyholder may terminate the Group Policy by giving us Written notice. The effective date of termination will be the later of:

1. The date stated in the notice.

2. The date we receive the notice.

We may terminate the Group Policy as follows:
9/2026 4 764999

1. On any Premium Due Date if the number of persons insured is less than the Minimum Participation Number or less than the Minimum Participation Percentage shown in the Coverage Features.

2. On any Premium Due Date if we determine that the Policyholder has failed to promptly furnish any necessary information requested by us, or has failed to perform any other obligations relating to the Group Policy.

3. On any Premium Due Date by giving the Policyholder not less than 60 days advance Written notice.

The minimum advance notice of such termination by us is 60 days.

G. Premium Adjustments
Premium adjustments involving a return of unearned premiums to the Policyholder will be limited to the 12 months just before the date we receive a request for premium adjustment.

H. Certificates
We will issue printed or electronic Certificates to the Policyholder or Employer showing the coverage under the Group Policy. The Policyholder or Employer will distribute a certificate to each insured Member. If the terms of the Certificate differ from the Group Policy, the terms stated in the Group Policy will govern.

I. Records And Reports
The Policyholder or Employer will furnish on our forms all information reasonably necessary to administer the Group Policy. We have the right at all reasonable times to inspect the payroll and other records of the Policyholder or Employer which relate to insurance under the Group Policy.

J. Agency, Release And Indemnification
Individuals selected by the Policyholder or by any Employer to secure coverage under the Group Policy or to perform their administrative function under it, represent and act on behalf of the person selecting them, and do not represent or act on behalf of Standard Insurance Company. The Policyholder, Employer, and such individuals have no authority to alter, expand, or extend our liability or to waive, modify or compromise any defense or right we may have under the Group Policy. The Policyholder and Employer are liable for their own negligent, intentional or wrongful acts or omissions, and those of any insurance broker/agent or administrator acting for or on behalf of either of them, arising from or connected with the administration of the Group Policy. The Policyholder and each Employer hereby release, hold harmless, and indemnify Standard Insurance Company from any liability arising from or related to any negligence, error, omission, misrepresentation, or dishonesty of any of them or their representatives, agency, or employees.

K. Notice Of Suit
The Policyholder and Employer shall promptly give us Written notice of any lawsuit or other legal proceedings arising under the Group Policy.

L. Entire Contract, Changes
The Group Policy constitutes the entire contract between the parties. A copy of the Policyholder's application is attached to the Group Policy when issued.

The Group Policy may be changed in whole or in part. No change in the Group Policy will be valid unless it is approved in Writing by one of our executive officers and given to the Policyholder for attachment to the Group Policy. No agent has authority to change the Group Policy or to waive any of its provisions.

M. Effect On Workers' Compensation, State Disability Insurance The coverage provided under the Group Policy is not a substitute for coverage under a workers' compensation or state disability income benefit law and does not relieve the Policyholder or Employer of any obligation to provide such coverage.

LI.PH.OT.1

NOTICE OF PROTECTION PROVIDED BY CALIFORNIA LIFE AND HEALTH

INSURANCE GUARANTEE ASSOCIATION
This notice provides a brief summary regarding the protections provided to policyholders by the California Life and Health Insurance Guarantee Association ("the Association").

The purpose of the Association is to assure that policyholders will be protected, within certain limits, in the unlikely event that a member insurer of the Association becomes financially unable to meet its obligations. Insurance companies licensed in California to sell life insurance, health insurance, annuities and structured settlement annuities are members of the Association. The protection provided by the Association is not unlimited and is not a substitute for consumers’ care in selecting insurers. This protection was created under California law, which determines who and what is covered and the amounts of coverage.

Below is a brief summary of the coverages, exclusions and limits provided by the Association. This summary does not cover all provisions of the law; nor does it in any way change anyone’s rights or obligations or the rights or obligations of the Association.

COVERAGE
 Persons Covered
Generally, an individual is covered by the Association if the insurer was a member of the Association and the individual lives in California at the time the insurer is determined by a court to be insolvent. Coverage is also provided to policy beneficiaries, payees or assignees, whether or not they live in California  Amounts of Coverage
The basic coverage protections provided by the Association are as follows.  Life Insurance, Annuities and Structured Settlement Annuities For life insurance policies, annuities and structured settlement annuities, the Association will provide the following:
 Life Insurance
80% of death benefits but not to exceed $300,000
80% of cash surrender or withdrawal values but not to exceed $100,000  Annuities and Structured Settlement Annuities
80% of the present value of annuity benefits, including net cash withdrawal and net cash surrender values but not to exceed $250,000 The maximum amount of protection provided by the Association to an individual, for all life insurance, annuities and structured settlement annuities is $300,000, regardless of the number of policies or contracts covering the individual.
 Health Insurance
The maximum amount of protection provided by the Association to an individual, as of July 1, 2016, is $546,741. This amount will increase or decrease based upon changes in the health care cost component of the consumer price index to the date on which an insurer becomes an insolvent insurer. Changes to this amount will be posted on the Association’s website www.califega.org.

COVERAGE LIMITATIONS AND EXCLUSIONS FROM COVERAGE
The Association may not provide coverage for this policy. Coverage by the Association generally requires residency in California. You should not rely on coverage by the Association in selecting an insurance company or in selecting an insurance policy.

The following policies and persons are among those that are excluded from Association coverage:
 A policy or contract issued by an insurer that was not authorized to do business in California when it issued the policy or contract
 A policy issued by a health care service plan (HMO), a hospital or medical service organization, a charitable organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company, an insurance exchange, or a grants and annuities society
 If the person is provided coverage by the guaranty association of another state  Unallocated annuity contracts; that is, contracts which are not issued to and owned by an individual and which do not guaranty annuity benefits to an individual  Employer and association plans, to the extent they are self-funded or uninsured  A policy or contract providing any health care benefits under Medicare Part C or Part D
 An annuity issued by an organization that is only licensed to issue charitable gift annuities
 Any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as certain investment elements of a variable life insurance policy or a variable annuity contract  Any policy of reinsurance unless an assumption certificate was issued  Interest rate yields (including implied yields) that exceed limits that are specified in Insurance Code Section 1067.02(b)(2)(C).

NOTICES
Insurance companies or their agents are required by law to give or send you this notice.

Policyholders with additional questions should first contact their insurer or agent. To learn more about coverages provided by the Association, please visit the Association’s website at www.califega.org, or contact either of the following:

California Life and Health Insurance California Department of Insurance Guarantee Association Consumer Communications Bureau
PO Box 16860 300 South Spring Street
Beverly Hills, CA 90209-3319 Los Angeles CA 90013
(323) 782-0182 (800) 927-4357
Insurance companies and agents are not allowed by California law to use the existence of the Association or its coverage to solicit, induce or encourage you to purchase any form of insurance. When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between this notice and California law, then California law will control.

CALIFORNIA NOTICE OF COMPLAINT PROCEDURE
Should any dispute arise about your premium or about a claim that you have filed, write to the company that issued the group policy at:

Standard Insurance Company
PO Box 711
Portland, OR 97207
(503) 321-7000
If the problem is not resolved, you may also write to the State of California at:

Department of Insurance
Consumer Services Division
300 S. Spring Street, 9th FL
Los Angeles, CA 90013
1-800-927-HELP (4357)
www.insurance.ca.gov/0500-about-us/02-department/030-csmcb/consumerservices.cfm This notice of complaint procedure is for information only and does not become a part or condition of this group policy/certificate.

STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282
(503) 321-7000

CERTIFICATE

GROUP LIFE INSURANCE
Policyholder: City Of Anaheim [retirees]
Policy Number: 764999
Effective Date: January 1, 2027
Revision Date: Not applicable
The Group Policy has been issued to the Policyholder.

We certify that you will be insured as provided by the terms of your Employer’s coverage under the Group Policy. If the terms of this Certificate differs from the terms of your Employer’s coverage under the Group Policy, the latter will govern. If your coverage is changed by an amendment to the Group Policy, we will provide the Policyholder with a revised Certificate or other notice to be given to you.

This policy includes an Accelerated Death Benefit. Death benefits will be reduced if an Accelerated Death Benefit is paid. The receipt of this benefit may be taxable and may affect your eligibility for Medicaid or other government benefits or entitlements. However, if you meet the definition of “terminally ill individual” in Internal Revenue Code section 101, your Accelerated Death Benefit may be non-taxable. You should consult your personal tax and/or legal advisor before you apply for an Accelerated Death Benefit.

Possession of this Certificate does not necessarily mean you are insured. You are insured only if you meet the requirements set out in this Certificate.

Unless defined differently within a particular provision, the terms "you" and "your" mean the Member. "We", "us", and "our" mean Standard Insurance Company. Other defined terms appear with their initial letters capitalized. Section headings, and references to them, appear in bold face type.

If you are a resident of California and age 65 or older on the date your coverage under the Group Policy becomes effective, for which you are required to pay all or part of the premium, you have 30 days from the date you first receive your Certificate to cancel your coverage. Upon receiving your cancellation request, we will void coverage from its inception as if the Certificate had not been issued and we will refund any premiums paid.

President and CEO
GC1219-LIFE

TABLE OF CONTENTS
COVERAGE FEATURES .............................................................................................................................. 1 GENERAL POLICY INFORMATION ...................................................................................................... 1 BECOMING INSURED ........................................................................................................................... 1 PREMIUM CONTRIBUTIONS ................................................................................................................ 1 SCHEDULE OF INSURANCE ................................................................................................................ 1 REDUCTIONS IN INSURANCE ............................................................................................................. 1 OTHER PROVISIONS ............................................................................................................................ 2 INSURING CLAUSE ..................................................................................................................................... 3 EVIDENCE OF INSURABILITY .................................................................................................................... 3 LIFE INSURANCE ........................................................................................................................................ 3 A. Amount Of Life Insurance .................................................................................................................. 3 B. When Life Insurance Becomes Effective ........................................................................................... 3 E. When Life Insurance Ends ................................................................................................................. 3 F. Reinstatement Of Life Insurance ........................................................................................................ 3 REPATRIATION BENEFIT ........................................................................................................................... 3 RIGHT TO CONVERT .................................................................................................................................. 3 CLAIMS ......................................................................................................................................................... 5 ASSIGNMENT .............................................................................................................................................. 7 BENEFIT PAYMENT AND BENEFICIARY PROVISIONS ........................................................................... 7 RIGHT TO RECOVERY ................................................................................................................................ 9 CLAIMANT COOPERATION ........................................................................................................................ 9 AGENCY, RELEASE AND INDEMNIFICATION........................................................................................... 9 TIME LIMITS ON LEGAL ACTIONS ........................................................................................................... 10 INCONTESTABILITY OF INSURANCE ...................................................................................................... 10 CLERICAL ERROR, MISSTATEMENT AND AGENCY ............................................................................. 10 DEFINITIONS ............................................................................................................................................. 10

INDEX OF DEFINED TERMS
AD&D Insurance, 10
Annual Earnings, 10
Beneficiary, 8
Child, 11
Contributory, 11
Conversion Period, 4
Dependent, 11
Dependent Life Insurance, 11
Domestic Partner, 12
Eligibility Waiting Period, 11
Employer, 11
Evidence Of Insurability, 11
Group Policy, 11
Group Policy Effective Date, 1
Group Policy Number, 1
Hospital, 12
Injury, 12
Insurance (Right To Convert), 4
Life Insurance, 12
Noncontributory, 12
Nursing Home, 12
Physician, 12
Policyholder, 1
Pregnancy, 12
Prior Plan, 12
Proof Of Loss, 5
Qualifying Event, 4
Recipient, 9
Sickness, 12
Signed, 12
Spouse, 12
Writing or Written, 12
9/2026 1 764999

COVERAGE FEATURES
This section contains many of the features of your group life insurance. Other provisions, including exclusions and limitations, appear in other sections. Please refer to the text of each section for full details.

The Table of Contents and the Index of Defined Terms help locate sections and definitions.

GENERAL POLICY INFORMATION
Group Policy Number: 764999
Type of Insurance Provided:

Life Insurance: Yes
Accidental Death And
Dismemberment (AD&D) Insurance: No
Dependent Life Insurance No
Policyholder: City Of Anaheim
Employer(S): City Of Anaheim
Group Policy Effective Date: January 1, 2027
Revision Date: Not applicable
State of Issue: California

BECOMING INSURED
To become insured for Life Insurance you must: (a) Be a Member; (b) Complete your Eligibility Waiting Period; and (c) Meet the requirements in Life Insurance. The requirements for becoming insured for coverages other than Life Insurance are set out in the text.

Member means an employee of the Employer who retired under the Employer's retirement program on or after January 1, 2027, and who was insured for basic life insurance on the day prior to retirement.

Eligibility Waiting Period: If you are a Member on the Group Policy Effective Date, you are eligible on that date. If you become a Member after the Group Policy Effective Date, you are eligible on the date you become a Member.

PREMIUM CONTRIBUTIONS
Life Insurance: Contributory

SCHEDULE OF INSURANCE

SCHEDULE OF LIFE INSURANCE
Life Insurance Benefit: An amount equal to $50 for each complete 6-month period of service for your Employer on the date you retire to a maximum benefit of $2,000.

REDUCTIONS IN INSURANCE
Your insurance will not be reduced because of your age. 9/2026 2 764999

OTHER PROVISIONS
Repatriation Benefit: The lesser of (1) $5,000; or (2) 100% of the expenses incurred to transport your body to a mortuary near your primary place of residence including expenses to prepare the body for shipment.

Waiver Of Premium: No
9/2026 3 764999

INSURING CLAUSE
If you die or have a loss while insured under the Group Policy, we will pay benefits according to the terms of the Group Policy after we receive Proof Of Loss satisfactory to us, subject to the Claims provision.

LI.IC.OT.1

EVIDENCE OF INSURABILITY
Evidence of Insurability is not required.

LI.EOI.OT.1

LIFE INSURANCE
A. Amount Of Life Insurance
See Coverage Features for the Life Insurance schedule.

B. When Life Insurance Becomes Effective
The Coverage Features states whether your Life Insurance is Contributory or Noncontributory.

Subject to the Active Work Provisions, your Life Insurance becomes effective on the date you become eligible.

C. When Life Insurance Ends
Your Life Insurance ends automatically on the earliest of:

1. The date the last period ends for which a premium was paid for your Life Insurance.

2. The date the Group Policy terminates.

3. The date your Employer’s coverage under the Group Policy terminates.

D. Reinstatement Of Life Insurance
If your Life Insurance ends, you may not become insured again.

LI.LF.OT.1

REPATRIATION BENEFIT
The amount of the Repatriation Benefit is shown in the Coverage Features.

We will pay a Repatriation Benefit if all of the following requirements are met:

1. A Life Insurance Benefit is payable because of your death.

2. You die more than 200 miles from your primary place of residence.

3. Expenses are incurred to transport your body to a mortuary near your primary place of residence, including expenses to prepare the body for shipment.

LI.RB.OT.1

RIGHT TO CONVERT
A. Right To Convert
You and your Dependents may buy an individual policy of life insurance without Evidence Of Insurability if all of the following requirements are met:

1. Your or your Dependents Insurance ends or is reduced due to a Qualifying Event. 9/2026 4 764999

2. You or your Dependents apply in Writing and pay us the first premium during the Conversion Period.

The maximum amount you and your Dependents have a Right To Convert is the amount of your Insurance which ended, except as limited under C. Limits On Right To Convert.

B. Definitions For Right To Convert

1. Conversion Period means the 31-day period after the date of any Qualifying Event.

2. Insurance means your Life Insurance and your Dependent Life Insurance under the Group Policy, excluding AD&D Insurance.

3. Qualifying Event means termination or reduction of your or your Dependents' Insurance for any reason except:
a. The Member’s failure to make a required premium contribution. b. Payment of an Accelerated Death Benefit.

C. Limits On Right To Convert
If your or your Dependents' Insurance ends or is reduced because of termination or amendment of the Group Policy, the following will apply.

1. You and your Dependents may not convert Insurance which has been in effect for less than 5 years.

2. The maximum amount that may be converted is the lesser of:
a. The amount of Insurance which ended, minus any other group life insurance for which you and your Dependents become eligible during the Conversion Period. b. $2,000.

D. The Individual Policy
You and your Dependents may select an individual whole life insurance policy we issue to persons of your or your Dependents age, except:

1. A policy with disability, accidental death, or other additional benefits.

2. A policy in an amount less than the minimum amount we issue.

The individual policy of life insurance will become effective on the day after the end of the Conversion Period. We will use our published rates for standard risks to determine the premium.

E. Death During The Conversion Period
If you or your Dependents die during the Conversion Period, we will pay a death benefit equal to the maximum amount you or your Dependents had a Right To Convert, whether or not you or your Dependents applied for an individual policy. In no event will the benefits paid exceed the amount in effect under the Group Policy on the day before your or your Dependent's Qualifying Event.

If you or your Spouse apply for an individual policy of life insurance, and death occurs during the Right To Convert Period, and if you or your Spouse name a Beneficiary in your or your Spouse's application that is different from the last Beneficiary you or your Spouse named under the Group Policy, then it will be considered a change of Beneficiary to the person named in the application. The change will take effect on the date of the application.

LI.RC.OT.1
9/2026 5 764999
CLAIMS
A. Filing A Claim
Claims should be filed on our forms. If we do not provide our forms within 15 days after they are requested, the claim may be submitted in a letter to us.

For Waiver Of Premium and Accelerated Death Benefit, the letter should include the character and the extent of the occurrence or loss which are being claimed, as required in item C. Proof Of Loss.

Subject to the time period in item B. Time Limits On Filing Proof Of Loss, such letter will constitute notice.

B. Time Limits On Filing Proof Of Loss
Proof Of Loss must be provided within 90 days after the date of the loss. If that is not possible, it must be provided as soon as reasonably possible, but not later than one year after the 90-day period.

With respect to coma, we will require Proof Of Loss of the comatose condition at reasonable intervals.

If proof is not given within 90 days, benefits payable for coma will end.

If Proof Of Loss is filed outside these time limits, the claim will be denied. These limits will not apply while the Member or Beneficiary lacks legal capacity.

C. Proof Of Loss
Proof Of Loss means Written proof that a loss occurred:

1. For which the Group Policy provides benefits;

2. Which is not subject to any exclusions; and

3. Which meets all other conditions for benefits.

Proof Of Loss includes any other information we may reasonably require in support of a claim. Proof Of Loss must be in Writing and must be provided at the expense of the claimant.

D. Time Limits On Filing Proof Of Loss For Waiver Of Premium Proof Of Loss for Waiver Of Premium must be provided within 12 months after the end of the Waiting Period. Failure to furnish Proof Of Loss will not invalidate or reduce any claim if it can be shown that it was not reasonably possible to furnish such Proof Of Loss, provide it is furnished as soon as reasonably possible.

Proof Of Loss is provided outside the 12 month time limit noted above, the claim may be denied. This limit will not apply while the Member or Beneficiary lacks legal capacity.

We will require further Proof Of Loss at reasonable intervals, but not more often than once a year after you have been continuously Totally Disabled for two years.

E. Time Limits On Filing Proof Of Loss For Accelerated Death Benefit With respect to Accelerated Death Benefit, we will require Proof Of Loss of your Qualifying Medical Condition. If Proof Of Loss of the Qualifying Medical Condition is not provided, the claim may be denied.

F. Investigation Of Claim
We may have you examined at our expense at reasonable intervals. Any such examination will be conducted by specialists of our choice.

We may have an autopsy performed at our expense, except where prohibited by law.

G. Time Of Payment
We will pay benefits within 60 days after the latest date shown below:

1. The date Proof Of Loss is satisfied.
9/2026 6 764999

2. The date we receive sufficient information to determine liability, the extent of liability and the appropriate payee legally entitled to benefits.

3. The date that legal impediments to payment of benefits that depend on the action of parties other than us are resolved and sufficient evidence of resolution is provided to us. Legal impediments to payment include, but are not limited to:
a. The establishment of guardianships or conservatorships. b. The appointment and qualification of trustees, executors and administrators. c. The submission of information required to satisfy state or federal reporting requirements.

Interest, if applicable, will accrue 30 days from the latest of the dates shown above, continuing up to the date of payment.

Payment made in good faith shall discharge us of liability to the extent of such payment.

H. Notice Of Decision On Claim
We will evaluate a claim for benefits promptly after we receive it. With respect to all claims except Waiver Of Premium claims, within 90 days after we receive the claim we will send the claimant: (a) a Written decision on the claim; or (b) a notice that we are extending the period to decide the claim for an additional 90 days.

With respect to Waiver Of Premium claims, within 45 days after we receive the claim we will send the claimant: (a) a Written decision on the Waiver Of Premium claim; or (b) a notice that we are extending the period to decide the claim for 30 days. Before the end of this extension period we will send the claimant: (a) a Written decision on the Waiver Of Premium claim; or (b) a notice that we are extending the period to decide the claim for an additional 30 days. If an extension is due to the claimant's failure to provide information necessary to decide the Waiver Of Premium claim, the extended time period for deciding the claim will not begin until the claimant provides the information or otherwise responds.

If we extend the period to decide the claim, we will notify the claimant of the following: (a) the reasons for the extension; (b) when we expect to decide the claim; (c) an explanation of the standards on which entitlement to benefits is based; (d) the unresolved issues preventing a decision; and (e) any additional information we need to resolve those issues.

If we request additional information, the claimant will have 45 days to provide the information. If the claimant does not provide the requested information within 45 days, we may decide the claim based on the information we have received.

If we deny any part of the claim, we will send the claimant a Written notice of denial containing the following:

1. The reasons for our decision.

2. Reference to the parts of the Group Policy on which our decision is based.

3. A copy of any internal rule or guideline relied upon in making our Waiver Of Premium decision, or a statement that no such rules or guidelines exist.

4. A description of any additional information needed to support the claim.

5. Information concerning the claimant’s right to receive, free of charge, copies of non-privileged documents and records relevant to the claim.

6. Information concerning the claimant's right to a review of our decision.

I. Review Procedure
If all or part of a claim is denied, the claimant may request a review. The claimant must request a review in Writing:

1. Within 180 days after receiving notice of the denial of a claim for Waiver Of Premium. 9/2026 7 764999

2. Within 60 days after receiving notice of the denial of any other claim.

The claimant may send us Written comments or other items to support the claim. The claimant may review and receive copies of any non-privileged information that is relevant to the request for review.

There will be no charge for such copies. Our review will include any Written comments or other items the claimant submits to support the claim.

We will review the claim promptly after we receive the request. With respect to all claims except Waiver Of Premium claims, within 60 days after we receive the request for review we will send the claimant:
(a) a Written decision on review; or (b) a notice that we are extending the review period for 60 days.

With respect to Waiver Of Premium claims, within 45 days after we receive the request for review we will send the claimant: (a) a Written decision on review; or (b) a notice that we are extending the review period for 45 days.

If an extension is due to the claimant's failure to provide information necessary to decide the claim on review, the extended time period for review of the claim will not begin until the claimant provides the information or otherwise responds.

If we extend the review period, we will notify the claimant of the following: (a) the reasons for the extension; (b) when we expect to decide the claim on review; and (c) any additional information we need to decide the claim.

If we request additional information, the claimant will have 45 days to provide the information. If the claimant does not provide the requested information within 45 days, we may conclude our review of the claim based on the information we have received.

With respect to Waiver Of Premium claims, the person conducting the review will be someone other than the person who denied the claim and will not be subordinate to that person. The person conducting the review will not give deference to the initial denial decision. If the denial was based on a medical judgement, the person conducting the review will consult with a qualified health care professional. This health care professional will be someone other than the person who made the original medical judgement and will not be subordinate to that person. The claimant may request the names of medical or vocational experts who provided advice to us about a claim for Waiver Of Premium.

If we deny any part of the claim on review, the claimant will receive a Written notice of denial containing the following:

1. The reasons for our decision.

2. Reference to the parts of the Group Policy on which our decision is based.

3. A copy of any internal rule or guideline relied upon in making our Waiver Of Premium decision, or a statement that no such rules or guidelines exist.

4. Information concerning the claimant’s right to receive, free of charge, copies of non-privileged documents and records relevant to the claim.

LI.CL.CA.1

ASSIGNMENT
The rights and benefits under the Group Policy cannot be assigned.

LI.AS.OT.1

BENEFIT PAYMENT AND BENEFICIARY PROVISIONS
A. Payment Of Benefits

1. Except as provided in item 2 below, benefits payable because of your death will be paid to the Beneficiary you named. Benefits payable because of coma will be paid to the Beneficiary you name.

See B through E of this section.
9/2026 8 764999

2. The Repatriation Benefit will be paid to the person who incurs the transportation expenses.

B. Naming A Beneficiary
Beneficiary means a person you name to receive your death benefits. You may name one or more Beneficiaries.

If you name two or more Beneficiaries in a class:

1. Two or more surviving Beneficiaries will share equally, unless you provide for unequal shares.

2. If you provide for unequal shares in a class, and two or more Beneficiaries in that class survive, we will pay each surviving Beneficiary his or her designated share. Unless you provided otherwise, we will then pay the share(s) otherwise due to any deceased Beneficiary(ies) to the surviving Beneficiaries pro rata based on the relationship that the designated percentage or fractional share of each surviving Beneficiary bears to the total shares of all surviving Beneficiaries.

3. If only one Beneficiary in a class survives, we will pay the total death benefits to that Beneficiary.

You may name or change Beneficiaries at any time without the consent of a Beneficiary.

Your Beneficiary designations must be the same for Life Insurance and AD&D Insurance death benefits.

Your designation must meet all of the following requirements:

1. You must name or change Beneficiaries in Writing. Writing includes a form Signed by you or a verification from us or our designated agent, the Policyholder or the Policyholder’s designated agent, or the Employer or the Employer’s designated agent of an electronic or telephonic designation made by you.

2. Must be dated.

3. Must be delivered to us or our designated agent, the Policyholder or the Policyholder’s designated agent, or the Employer or the Employer’s designated agent, during your lifetime.

4. Must relate to the insurance provided under the Group Policy.

Your designation will take effect on the date it is received by us or our designated agent, the Policyholder or the Policyholder’s designated agent, or the Employer or the Employer’s designated agent.

If we approve it, a designation which meets the requirements of a Prior Plan will be accepted as your Beneficiary designation under the Group Policy.

C. Simultaneous Death Provision
If a Beneficiary or a person in one of the classes listed in item D. No Surviving Beneficiary dies on the same day you die, or within 15 days thereafter, benefits will be paid as if that Beneficiary or person had died before you, unless Proof Of Loss with respect to your or your Spouse's death is delivered to us before the date of the Beneficiary's death.

D. No Surviving Beneficiary
If you do not name a Beneficiary or if you are not survived by one, benefits will be paid in equal shares to the first surviving class of the classes below.

1. Your spouse/Spouse.

2. Your children.

3. Your parents.

4. Your brothers and sisters.

5. Your estate.
9/2026 9 764999
E. Method Of Payment
Recipient means a person who is entitled to benefits under this Benefit Payment and Beneficiary Provisions section.

1. Lump Sum
If the amount payable to a Recipient is less than $25,000, we will pay it in a lump sum.

2. Standard Secure Access Checking Account
If the amount payable to a Recipient is $25,000 or more, we will deposit it into a Standard Secure Access checking account which:
a. Bears interest at a rate equal to the 13-week Treasury Bill (T-Bill) auction rate, but not to exceed 5%.
b. Is owned by the Recipient.
c. Is subject to the terms and conditions of a confirmation certificate which will be given to the Recipient.
d. Is fully guaranteed by us.

To the extent permitted by law, the amount payable to the Recipient will not be subject to any legal process or to the claims of any creditor or creditor's representative.

LI.BB.OT.1

RIGHT TO RECOVERY
If benefits have been overpaid on any claim then full reimbursement to us is required within 60 days of notification to you, your Beneficiary or your estate. If reimbursement is not made then we have the right to do any of the following:

1. Reduce future benefits until full reimbursement is made.

2. Recover such overpayments from you, your Beneficiary or your estate.

Such reimbursement is required whether the overpayment is due to fraud, our error in processing a claim or any other reason.

LI.RR.OT.1

CLAIMANT COOPERATION
If you or your Beneficiary fails to cooperate with us in the administration of your claim, we may close or deny the claim. Such cooperation includes, but is not limited to, providing any information or documentation needed to determine if benefits are payable or the actual benefit amount due.

LI.CLC.OT.1

AGENCY, RELEASE AND INDEMNIFICATION
Individuals selected by the Policyholder or by any Employer to secure coverage under the Group Policy or to perform their administrative function under it, represent and act on behalf of the person selecting them, and do not represent or act on behalf of Standard Insurance Company. The Policyholder, Employer and such individuals have no authority to alter, expand or extend our liability or to waive, modify or compromise any defense or right we may have under the Group Policy. The Policyholder and each Employer hereby release, hold harmless and indemnify Standard Insurance Company from any liability arising from or related to any negligence, error, omission, misrepresentation or dishonesty of any of them or their representatives, agency or employees.

LI.AR.OT.1
9/2026 10 764999

TIME LIMITS ON LEGAL ACTIONS
No action at law or in equity may be brought until 60 days after we have been given Proof Of Loss. No such action may be brought more than three years after the adverse decision date.

LI.TL.OT.1

INCONTESTABILITY OF INSURANCE
Any statement made to obtain or to increase insurance is, in the absence of fraud, a representation and not a warranty.

No misrepresentation will be used to reduce or deny a claim unless all of the following requirements are met:

1. The insurance would not have been approved for you, your Spouse or your Child if we had known the truth.

2. We have given you or any other person claiming benefits a copy of the Signed Written instrument which contains the misrepresentation.

We will not use a misrepresentation to reduce or deny a claim after your, your Spouse's or your Child's insurance has been in effect for two years during the lifetime of the insured, your Spouse or your Child.

LI.IN.OT.1

CLERICAL ERROR, MISSTATEMENT AND AGENCY
A. Clerical Error And Agency
Clerical error by us, the Policyholder, your Employer, or their respective employees or representatives will not:

1. Cause a person to become insured.

2. Invalidate insurance under the Group Policy otherwise validly in force.

3. Continue insurance under the Group Policy otherwise validly terminated.

The Policyholder and your Employer act on their own behalf as your agent, and not as our agent. The Policyholder and your Employer have no authority to alter, expand or extend our liability or to waive, modify or compromise any defense or right we may have under the Group Policy.

B. Misstatement Of Age
If a person's age has been misstated, we will make an equitable adjustment of premiums, benefits, or both. The adjustment will be based on:

1. The amount of insurance based on the correct age.

2. The difference between the premiums paid and the premiums which would have been paid if the age had been correctly stated.

LI.CE.OT.1

DEFINITIONS
AD&D Insurance means accidental death and dismemberment insurance, if any under the Group Policy.

Annual Earnings means your annual rate of earnings from your Employer. Your Annual Earnings will be based on your earnings in effect on your last full day of Active Work.

Annual Earnings includes:

1. Contributions you make through a salary reduction agreement with your Employer to:
9/2026 11 764999
a. An Internal Revenue Code (IRC) Section 401(k), 403(b), 408(k), or 457 deferred compensation arrangement; or
b. An executive nonqualified deferred compensation arrangement.

2. Amounts contributed to your fringe benefits according to a salary reduction agreement under an IRC Section 125 Plan.

Annual Earnings does not include:

1. Bonuses.

2. Commissions.

3. Overtime pay.

4. Stock options or stock bonuses.

5. Your Employer’s contributions on your behalf to any deferred compensation arrangement or pension plan.

6. Any other extra compensation.

Child means:

1. Your child from live birth through age 25.

2. Your disabled child who is 26 years of age or older, is your qualifying child as defined by the Internal Revenue Service for whom you or your Spouse claims as a dependent on Federal Income Taxes filed for the preceding calendar year and meets one of the following requirements:
a. Has been insured continuously under the Group Policy prior to reaching age 26. b. Who is 26 years of age or older at the time of your initial eligibility under the Group Policy.

3. Child includes any of the following, if they otherwise meet the definition of Child:
a. Your adopted child.
b. Your stepchild if living in your home.

Contributory means you pay all or part of the premium for insurance.

Dependent means your Spouse or Child.

Dependent Life Insurance means Dependent Life Insurance For Your Spouse and/or Dependent Life Insurance For Your Child, if any, under the Group Policy. It may also be referred to as Spouse Life Insurance Benefit and/or Child Life Insurance Benefit as applicable.

Eligibility Waiting Period means the period you must be a Member before you become eligible for insurance.

See Coverage Features.

Employer means an employer for which coverage under the Group Policy is approved in Writing by us. See Coverage Features.

Evidence Of Insurability means an applicant must do all of the following:

1. Complete and sign our medical history statement.

2. Sign our form authorizing us to obtain information about the applicant's health.

3. Undergo a physical examination, if required by us, which may include blood testing.

4. Provide any additional information about the applicant's insurability that we may reasonably require.

Group Policy means this group life insurance policy issued by us to the Policyholder and identified by the Group Policy Number, the Policyholder’s attached application, group life insurance Certificates with the same Group Policy Number, and any amendments to the Group Policy or Certificates. 9/2026 12 764999
Hospital means a legally operated hospital providing full-time medical care and treatment under the direction of a full-time staff of licensed Physicians.

Injury means an injury to the body.

Life Insurance means life insurance under the Group Policy.

Noncontributory means the Policyholder or Employer pays the entire premium for insurance.

Nursing Home means a licensed institution operated for the purpose of providing nursing care and treatment for individuals which provides 24-hour nursing services under the direction and supervision of a Physician.

Physician means a licensed M.D. or D.O., acting within the scope of the license. Physician does not include you or your Spouse, or the brother, sister, parent or child of either you or your Spouse.

Pregnancy means your pregnancy, childbirth, or related medical conditions, including complications of pregnancy.

Prior Plan means your Employer’s group life insurance plan in effect on the day before the effective date of your Employer’s coverage under the Group Policy and which is replaced by the Group Policy.

Sickness means your sickness, illness or disease.

Signed means any symbol or method executed or adopted by you with the present intention to authenticate a record, and which is on or transmitted by paper, electronic or telephonic media, and which is consistent with applicable law, and authorized or accepted by us.

Spouse means:

1. A person to whom you are legally married; or

2. Your Domestic Partner. Domestic Partner means an individual recognized as such under California state law.

However, for the purposes of insurance under the Group Policy, Spouse does not include a person who is a full-time member of the armed forces of any country or a person from whom you are divorced or legally separated.

Writing or Written means a record which is on or transmitted by paper, electronic or telephonic media, and which is consistent with applicable law, and authorized or accepted by us.

LI.DF.CA.1

NOTICE OF PROTECTION PROVIDED BY

CALIFORNIA LIFE AND HEALTH INSURANCE GUARANTEE ASSOCIATION This notice provides a brief summary regarding the protections provided to policyholders by the California Life and Health Insurance Guarantee Association ("the Association"). The purpose of the Association is to assure that policyholders will be protected, within certain limits, in the unlikely event that a member insurer of the Association becomes financially unable to meet its obligations. Insurance companies licensed in California to sell life insurance, health insurance, annuities and structured settlement annuities are members of the Association. The protection provided by the Association is not unlimited and is not a substitute for consumers’ care in selecting insurers. This protection was created under California law, which determines who and what is covered and the amounts of coverage.

Below is a brief summary of the coverages, exclusions and limits provided by the Association. This summary does not cover all provisions of the law; nor does it in any way change anyone’s rights or obligations or the rights or obligations of the Association.

COVERAGE
 Persons Covered
Generally, an individual is covered by the Association if the insurer was a member of the Association and the individual lives in California at the time the insurer is determined by a court to be insolvent. Coverage is also provided to policy beneficiaries, payees or assignees, whether or not they live in California.  Amounts of Coverage
The basic coverage protections provided by the Association are as follows.  Life Insurance, Annuities and Structured Settlement Annuities For life insurance policies, annuities and structured settlement annuities, the Association will provide the following:
 Life Insurance
80% of death benefits but not to exceed $300,000
80% of cash surrender or withdrawal values but not to exceed $100,000  Annuities and Structured Settlement Annuities
80% of the present value of annuity benefits, including net cash withdrawal and net cash surrender values but not to exceed $250,000
The maximum amount of protection provided by the Association to an individual, for all life insurance, annuities and structured settlement annuities is $300,000, regardless of the number of policies or contracts covering the individual.
 Health Insurance
The maximum amount of protection provided by the Association to an individual, as of July 1, 2016, is $546,741.

This amount will increase or decrease based upon changes in the health care cost component of the consumer price index to the date on which an insurer becomes an insolvent insurer. Changes to this amount will be posted on the Association’s website www.califega.org.

COVERAGE LIMITATIONS AND EXCLUSIONS FROM COVERAGE
The Association may not provide coverage for this policy. Coverage by the Association generally requires residency in California. You should not rely on coverage by the Association in selecting an insurance company or in selecting an insurance policy.

The following policies and persons are among those that are excluded from Association coverage:
 A policy or contract issued by an insurer that was not authorized to do business in California when it issued the policy or contract
 A policy issued by a health care service plan (HMO), a hospital or medical service organization, a charitable organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company, an insurance exchange, or a grants and annuities society
 If the person is provided coverage by the guaranty association of another state  Unallocated annuity contracts; that is, contracts which are not issued to and owned by an individual and which do not guaranty annuity benefits to an individual
 Employer and association plans, to the extent they are self-funded or uninsured  A policy or contract providing any health care benefits under Medicare Part C or Part D  An annuity issued by an organization that is only licensed to issue charitable gift annuities  Any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as certain investment elements of a variable life insurance policy or a variable annuity contract  Any policy of reinsurance unless an assumption certificate was issued  Interest rate yields (including implied yields) that exceed limits that are specified in Insurance Code Section 1067.02(b)(2)(C).

NOTICES
Insurance companies or their agents are required by law to give or send you this notice. Policyholders with additional questions should first contact their insurer or agent. To learn more about coverages provided by the Association, please visit the Association’s website at www.califega.org, or contact either of the following:

California Life and Health Insurance California Department of Insurance Guarantee Association Consumer Communications Bureau
PO Box 16860 300 South Spring Street
Beverly Hills, CA 90209-3319 Los Angeles CA 90013
(323) 782-0182 (800) 927-4357
Insurance companies and agents are not allowed by California law to use the existence of the Association or its coverage to solicit, induce or encourage you to purchase any form of insurance. When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between this notice and California law, then California law will control.

CALIFORNIA NOTICE OF COMPLAINT PROCEDURE
Should any dispute arise about your premium or about a claim that you have filed, write to the company that issued the group policy at:

Standard Insurance Company
PO Box 711
Portland, OR 97207
(503) 321-7000
If the problem is not resolved, you may also write to the State of California at:

Department of Insurance
Consumer Services Division
300 S. Spring Street, 9th FL
Los Angeles, CA 90013
1-800-927-HELP (4357)
www.insurance.ca.gov/0500-about-us/02-department/030-csmcb/consumer-services.cfm This notice of complaint procedure is for information only and does not become a part or condition of this group policy/certificate.

STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland Oregon 97204-1282
(503) 321-7000

GROUP ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE POLICY Policyholder: City Of Anaheim
Policy Number: 764999
Effective Date: January 1, 2027
The consideration for this Group Policy is the application of the Policyholder and the payment by the Policyholder of premiums as provided herein.

Subject to the Policyholder Provisions and the Incontestability Provisions, this Group Policy (a) is issued for the Initial Rate Guarantee Period shown in the Coverage Features, and (b) may be renewed for successive renewal periods by the payment of the premium set by us on each renewal date. The length of each renewal period will be set by us, but will not be less than 12 months.

For purposes of effective dates and ending dates under this Group Policy, all days begin and end at 12:00 midnight Standard Time at the Policyholder's address.

All provisions on this and the following pages are part of this Group Policy. "You" and "your" mean the Member. "We", "us", and "our" mean Standard Insurance Company. Other defined terms appear with their initial letters capitalized.

Section headings, and references to them, appear in boldface type.

STANDARD INSURANCE COMPANY
By
President and CEO Corporate Secretary
GP494-ADD/S399
Table of Contents
COVERAGE FEATURES ................................................................................................................................................................. 3 GENERAL POLICY INFORMATION ................................................................................................................................. 3 BECOMING INSURED ........................................................................................................................................................... 3 PREMIUM CONTRIBUTIONS ............................................................................................................................................. 4 SCHEDULE OF AD&D INSURANCE ................................................................................................................................. 4 REDUCTIONS IN INSURANCE .......................................................................................................................................... 5 OTHER PROVISIONS ............................................................................................................................................................. 5 PREMIUM RATES AND RENEWALS .............................................................................................................................. 5 ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE ..................................................................................... 6 A. Insuring Clause ................................................................................................................................................................ 6 B. Definition Of Loss ........................................................................................................................................................... 6 C. Amount Payable .............................................................................................................................................................. 6 D. Changes In AD&D Insurance Benefits ................................................................................................................... 6 E. AD&D Insurance Exclusions ...................................................................................................................................... 7 ADDITIONAL BENEFITS .............................................................................................................................................................. 7 WHEN AD&D INSURANCE BECOMES EFFECTIVE ........................................................................................................... 9 A. Becoming Insured For AD&D Insurance .............................................................................................................. 9 ACTIVE WORK PROVISIONS ...................................................................................................................................................... 9 WHEN AD&D INSURANCE ENDS .......................................................................................................................................... 10 REINSTATEMENT OF AD&D INSURANCE ........................................................................................................................ 10 CLAIMS ............................................................................................................................................................................................. 10 ASSIGNMENT................................................................................................................................................................................. 12 BENEFIT PAYMENT AND BENEFICIARY PROVISIONS ............................................................................................... 12 TIME LIMITS ON LEGAL ACTIONS ....................................................................................................................................... 14 INCONTESTABILITY PROVISIONS ....................................................................................................................................... 14 CLERICAL ERROR, AGENCY, AND MISSTATEMENT .................................................................................................... 15 TERMINATION OR AMENDMENT OF THE GROUP POLICY...................................................................................... 15 DEFINITIONS ................................................................................................................................................................................. 15 POLICYHOLDER PROVISIONS ................................................................................................................................................ 17 Index of Defined Terms
Active Work, Actively At Work, 9
Air Bag Benefit, 4, 7
Air Bag System, 8
Annual Earnings, 15
Automobile, 7
Beneficiary, 12
Career Adjustment Benefit, 4, 8
Child, 16
Child Care Benefit, 4, 8
Class Definition, 3
Contributory, 16
Domestic Partner, 16
Eligibility Waiting Period, 16
Employer(s), 3
Grace Period, 5
Group Policy, 16
Group Policy Effective Date, 3
Group Policy Number, 3
Higher Education Benefit, 4, 9
Initial Rate Guarantee Period, 5
Injury, 16
L.L.C. Owner-Employee, 16
Loss, 6
Member, 3
Noncontributory, 16
Notice of Rate Change, 5
P.C. Partner, 16
Physician, 16
Policyholder, 3
Pregnancy, 16
Premium Rates, 5
Prior Plan, 16
Proof Of Loss, 10
Recipient, 13
Repatriation Benefit, 4, 8
Seat Belt Benefit, 4, 7
Seat Belt System, 7
Sickness, 16
Spouse, 16
War, 7
9/2026 - 3 - 764999

COVERAGE FEATURES
This section contains many of the features of your group accidental death and dismemberment insurance (AD&D Insurance). Other provisions, including exclusions and limitations appear in other sections. Please refer to the text of each section for full details. The Table of Contents and the Index of Defined Terms help locate sections and definitions.

GENERAL POLICY INFORMATION
Group Policy Number: 764999
Policyholder: City Of Anaheim
Employer(S): City Of Anaheim
Group Policy Effective Date: January 1, 2027
Policy Issued in: California

BECOMING INSURED
To become insured for AD&D Insurance you must: (a) Be a Member; (b) Complete your Eligibility Waiting Period; and (c) Meet the requirements in When AD&D Insurance Becomes Effective and Active Work Provisions.

Definition of Member: You are a Member if you are:

1. An active city manager, city council member, AFSCME General Management, AFSCME professional, supervisory management, middle management, administrative management or executive management employee of the Employer; and

2. Regularly working at least 40 hours per week.

You are not a Member if you are:

1. A temporary or seasonal employee.

2. A leased employee.

3. An independent contractor.

4. A full time member of the armed forces of any country.

Class Definition:

Class 1: AFSCME General Management, AFSCME Professional/Technical Management, APMA, IBEW Management, and Unrepresented
Executive and Management
Class 2: City managers
Class 3: City council members
Eligibility Waiting Period: You are eligible on one of the following dates:

If you are a Member on the Group Policy Effective Date, you are eligible on that date.

If you become a Member after the Group Policy Effective Date, you are eligible on the first day following 90 consecutive days as a Member.
9/2026 - 4 - 764999

PREMIUM CONTRIBUTIONS
Members: Contributory

SCHEDULE OF AD&D INSURANCE
Member:

Class 1: $50,000. The amount payable for certain Losses is less than 100% of the AD&D Insurance Benefit. See AD&D Table Of Losses.

Class 2: $300,000. The amount payable for certain Losses is less than 100% of the AD&D Insurance Benefit. See AD&D Table Of Losses.

Class 3: $100,000. The amount payable for certain Losses is less than 100% of the AD&D Insurance Benefit. See AD&D Table Of Losses.

SCHEDULE OF ADDITIONAL AD&D INSURANCE
Seat Belt Benefit: The amount of the Seat Belt Benefit is the lesser of (1) $10,000 or (2) the amount of AD&D Insurance Benefit payable for Loss of your life.

Air Bag Benefit: The amount of the Air Bag Benefit is the lesser of (1) $5,000; or (2) the amount of AD&D Insurance Benefit payable for Loss of your life.

Repatriation Benefit: The expenses incurred to transport your body to a mortuary near your primary place of residence, reduced by the amount of the Repatriation Benefit paid under any Group Life Insurance Policy issued by us, but not to exceed $5,000 or 10% of the AD&D Insurance Benefit, whichever is less.

Career Adjustment Benefit: The tuition expenses for training incurred by your Spouse within 36 months after the date of your death, exclusive of board and room, books, fees, supplies and other expenses, reduced by the amount of the Career Adjust Benefit paid under any Group Life Insurance Policy issued by us, but not to exceed $5,000 per year, or the cumulative total of $10,000 or 25% of the AD&D Insurance Benefit, whichever is less.

Child Care Benefit: The total child care expense incurred by your Spouse within 36 months after the date of your death for all Children under age 13, reduced by the amount of the Child Care Benefit paid under any Group Life Insurance Policy issued by us, but not to exceed $5,000 per year, or the cumulative total of $10,000 or 25% of the AD&D Insurance Benefit, whichever is less.

Higher Education Benefit: The tuition expenses incurred per Child within 4 years after the date of your death at an accredited institution of higher education, exclusive of board and room, books, fees, supplies and other expenses, reduced by the amount of the Higher Education Benefit paid under any Group Life Insurance Policy issued by us, but not to exceed $5,000 per year, or the cumulative total of $20,000 or 25% of the AD&D Insurance Benefit, whichever is less.
9/2026 - 5 - 764999

AD&D TABLE OF LOSSES
The amount payable is a percentage of the AD&D Insurance Benefits in effect on the date of the accident and is determined by the Loss suffered as shown in the following table:

Loss: Percentage Payable:
a. Life 100%
b. One hand or one foot 50%
c. Sight in one eye, speech, or
hearing in both ears
50%
d. Two or more of the Losses listed
in b. and c. above
100%
e. Thumb and index finger of the same
hand
25%*
f. Quadriplegia 100%**
g. Triplegia 75%**
h. Hemiplegia 50%**
i. Uniplegia 25%**
j. Paraplegia 75%**
No more than 100% of your AD&D Insurance Benefit will be paid for all Losses resulting from one accident. * No AD&D Insurance Benefits will be paid for Loss of thumb and index finger of the same hand if an AD&D Insurance Benefit is payable for the Loss of that entire hand. ** No AD&D Insurance Benefit will be paid for loss of function of a hand or foot if an AD&D Insurance Benefit is payable for Quadriplegia, Hemiplegia, Triplegia, Uniplegia or Paraplegia involving that same hand or foot.

REDUCTIONS IN INSURANCE
Your insurance will not be reduced because of your age.

OTHER PROVISIONS
Annual Earnings based on: Earnings in effect on your last full day of Active Work.

PREMIUM RATES AND RENEWALS
Premium Rates: $0.025 monthly per $1,000 of AD&D Insurance Premium Due Dates: January 1, 2027, and the first day of each calendar month thereafter Grace Period: 60 days
Initial Rate Guarantee Period: January 1, 2027, to January 1, 2030 Notice of Rate Change: 180 days
9/2026 - 6 - 764999

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE
A. Insuring Clause
If you have an accident, including accidental exposure to adverse weather conditions, while insured under the Group Policy and the accident results in a Loss, we will pay benefits according to the terms of the Group Policy after we receive Proof Of Loss satisfactory to us.

B. Definition Of Loss
Loss means loss of life, hand, foot, sight, speech, hearing in both ears, thumb and index finger of the same hand and Quadriplegia, Hemiplegia, Triplegia, Uniplegia or Paraplegia which meets all of the following requirements:

1. Is caused solely and directly by an accident.

2. Occurs independently of all other causes.

3. Occurs within 365 days after the accident.

With respect to Loss of life, death will be presumed if you disappear and the disappearance:

1. Is caused solely and directly by an accident that reasonably could have caused Loss of life;

2. Occurs independently of all other causes; and

3. Continued for a period of 365 days after the date of the accident, despite reasonable search efforts.

With respect to a hand or foot, Loss means actual and permanent severance from the body at or above the wrist or ankle joints, whether or not surgically reattached.

With respect to sight, Loss means entire, uncorrectable, and irrecoverable loss of sight, as certified by a Diplomate of the American Board of Ophthalmology.

With respect to speech, Loss means entire and irrecoverable loss of audible speech, as certified by a Diplomate of the American Board of Otolaryngology.

With respect to hearing, Loss means entire, uncorrectable, and irrecoverable loss of hearing in both ears, as certified by a Diplomate of the American Board of Otolaryngology.

With respect to thumb and index finger of the same hand, Loss means actual and permanent severance from the body at or above the metacarpophalangeal joints.

With respect to Quadriplegia, Hemiplegia, Triplegia Uniplegia or Paraplegia, Loss must be certified by a licensed medical professional to be permanent, complete, and irreversible.

Quadriplegia means total paralysis of both upper and lower limbs. Hemiplegia means total paralysis of the upper and lower limbs on the same side of the body. Triplegia means total paralysis of three limbs. Paraplegia means total paralysis of both lower limbs. Uniplegia means total paralysis of one limb.

C. Amount Payable
The amount of AD&D Insurance Benefits is shown in the Coverage Features. The amount payable for certain Losses will differ.

D. Changes In AD&D Insurance Benefits

1. Increases
You must apply in writing for any increase in AD&D Insurance Benefits. Subject to the Active Work Provisions, an increase in AD&D Insurance Benefits becomes effective as follows:

An increase in AD&D Insurance Benefits becomes effective on the first day of the calendar month coinciding with or next following the date you apply for the increase. 9/2026 - 7 - 764999

2. Decreases
A decrease in AD&D Insurance Benefits because of a change in your age becomes effective on the first day of the calendar month coinciding with or next following the date of the change in your age.

Any other decrease in AD&D Insurance Benefits becomes effective on the first day of the calendar month coinciding with or next following the date the Policyholder receives your written request for the decrease.

E. AD&D Insurance Exclusions
No AD&D Insurance Benefits are payable if the accident or Loss is caused or contributed to by any of the following:

1. War or act of War. War means declared or undeclared war, whether civil or international, and any substantial armed conflict between organized forces of a military nature

2. Suicide or other intentionally self-inflicted Injury, while sane or insane.

3. Committing or attempting to commit an assault or felony, or actively participating in a violent disorder or riot.

Actively participating does not include being at the scene of a violent disorder or riot while performing official duties.

4. The voluntary use or consumption of any poison, chemical compound, alcohol or drug, unless used or consumed according to the directions of a Physician.

5. Sickness or Pregnancy existing at the time of the accident or exposure.

6. Heart attack or stroke.

7. Medical or surgical treatment or diagnostic procedure for any of the above. (NO DEPS_QPLGIA_HPLGIA_PPLGIA_REATTCHMNT) SA.AD.OT.1

ADDITIONAL BENEFITS
Seat Belt Benefit
The amount of the Seat Belt Benefit is shown in the Coverage Features.

We will pay a Seat Belt Benefit if you meet all of the following requirements:

1. You die as a result of an Automobile accident for which AD&D Insurance Benefits are payable for Loss of life; and

2. You were wearing and properly utilizing a Seat Belt System at the time of the accident, as evidenced by a police accident report.

The Seat Belt Benefit will be paid according to the Benefit Payment And Beneficiary Provisions in the same manner as the AD&D Insurance Benefits.

Seat Belt System means a properly installed combination lap and shoulder restraint system that meets the Federal Vehicle Safety Standards of the National Highway Traffic Safety Administration. Seat Belt System will include a lap belt alone, but only if the Automobile did not have a combination lap and shoulder restraint system when manufactured. Seat Belt System does not include a shoulder restraint alone.

Automobile means a motor vehicle licensed for use on public highways.

Air Bag Benefit
The amount of the Air Bag Benefit is shown in the Coverage Features.

We will pay an Air Bag Benefit if all of the following requirements are met:

1. You die as a result of an Automobile accident for which a Seat Belt Benefit is payable for Loss of life. 9/2026 - 8 - 764999

2. The Automobile is equipped with an Air Bag System that was installed as original equipment by the Automobile manufacturer and has received regular maintenance or scheduled replacement as recommended by the Automobile or Air Bag manufacturer.

3. You were seated in the driver's or a passenger's seating position intended to be protected by the Air Bag System and the respective Air Bag System deployed in the crash as evidenced by a police accident report.

The Air Bag Benefit will be paid according to the Benefit Payment And Beneficiary Provisions in the same manner as the AD&D Insurance Benefits
Air Bag System means an automatically inflatable passive restraint system that is designed to provide automatic crash protection in front or side impact Automobile accidents and meets the Federal Vehicle Safety Standards of the National Highway Traffic Safety Administration.

Automobile means a motor vehicle licensed for use on public highways.

Repatriation Benefit
The amount of the Repatriation Benefit is shown in the Coverage Features.

We will pay a Repatriation Benefit if all of the following requirements are met.

1. You die as a result of an accident for which AD&D Insurance Benefits are payable for Loss of life.

2. You are on the date of death, more than 200 miles from the deceased's primary place of residence.

3. Expenses are incurred to transport the body to a mortuary near the deceased's primary place of residence.

The Repatriation Benefit will be paid to the person who incurred the transportation expenses.

Career Adjustment Benefit
The amount of the Career Adjustment Benefit is shown in the Coverage Features.

We will pay a Career Adjustment Benefit if all of the following requirements are met:

1. You are insured under the Group Policy.

2. You die as a result of an accident for which AD&D Insurance Benefits are payable for Loss of your life.

3. Your Spouse is, within 36 months after the date of your death, registered and in attendance at an accredited institution of higher education or trades training program for the purpose of obtaining employment or increasing earnings.

The Career Adjustment Benefit will be paid to your surviving Spouse. If you have no surviving Spouse, no Career Adjustment Benefit will be paid.

Child Care Benefit
The amount of the Child Care Benefit is shown in the Coverage Features.

We will pay a Child Care Benefit if all of the following requirements are met:

1. You are insured under the Group Policy.

2. You die as a result of an accident for which AD&D Insurance Benefits are payable for Loss of your life.

3. Your Spouse pays a licensed child care provider who is not a member of your family for child care provided to your Child(ren) under age 13 within 36 months of your death.

4. The child care is necessary in order for your Spouse to work or to obtain training for work or to increase earnings.

The Child Care Benefit will be paid to your surviving Spouse. If you have no surviving Spouse, no Child Care Benefit will be paid.
9/2026 - 9 - 764999
Higher Education Benefit
The amount of the Higher Education Benefit is shown in the Coverage Features.

We will pay a Higher Education Benefit if all of the following requirements are met:

1. You are insured under the Group Policy.

2. You die as a result of an accident for which AD&D Insurance Benefits are payable for Loss of your life.

3. On the date of your death the Child meets one of the following requirements:
a. Is registered and in full-time attendance at an accredited institution of higher education beyond high school.
b. The Child is in the last year of high school before graduation and within one year is registered and in full-time attendance at an accredited institution of higher education beyond high school.

The Higher Education Benefit will be paid annually to each Child who meets the requirements of item 3.a above, for a maximum of 4 consecutive years beginning on the date of your death. No Higher Education Benefit will be paid if there is no Child eligible to receive it.
(NO DEPS) SA.BF.OT.1

WHEN AD&D INSURANCE BECOMES EFFECTIVE
A. Becoming Insured For AD&D Insurance
The Coverage Features states whether your AD&D Insurance is Contributory or Noncontributory. Subject to the Active Work Provisions, your AD&D Insurance becomes effective as follows:

1. Noncontributory AD&D Insurance
Noncontributory AD&D Insurance becomes effective on the date you become eligible.

2. Contributory AD&D Insurance
You must apply in writing for Contributory AD&D Insurance and agree to pay premiums. Contributory AD&D Insurance becomes effective on the later of:
a. The date you become eligible if you apply on or before that date. b. The date you apply, if you apply after you become eligible.

3. Takeover Provision
If you were insured under the Prior Plan on the day before the effective date of your Employer's coverage under the Group Policy, your Eligibility Waiting Period is waived on the effective date of your Employer's coverage under the Group Policy.
(NO DEPS) SA.EF.OT.1

ACTIVE WORK PROVISIONS
If you are incapable of Active Work because of Sickness, Injury or Pregnancy on the day before the scheduled effective date of your insurance or an increase in your insurance under the Group Policy, your insurance or increase in your insurance will not become effective until the day after you complete one full day of Active Work as an eligible Member.

Active Work and Actively At Work mean performing the material duties of your own occupation at your Employer's usual place of business.

You will also meet the Active Work requirement if:

1. You were absent from Active Work because of a regularly scheduled day off, holiday, or vacation day; 9/2026 - 10 - 764999

2. You were Actively At Work on your last scheduled work day before the date of your absence; and

3. You were capable of Active Work on the day before the scheduled effective date of your insurance or increase in your insurance.

SA.AW.OT.1

WHEN AD&D INSURANCE ENDS
AD&D Insurance ends automatically on the earliest of the following:

1. The date the last period ends for which a premium was paid for your AD&D Insurance.

2. The date the Group Policy terminates.

3. The date your employment terminates.

4. The date you cease to be a Member. However, if you cease to be a Member because you are not working the required minimum number of hours, your AD&D Insurance will be continued with payment of premium, during a leave of absence which is required by the federal or a state-mandated family or medical leave act or law, unless it ends under 1 through 3 above.
(NO DEPS_DOM) SA.EN.OT.1

REINSTATEMENT OF AD&D INSURANCE
If your AD&D Insurance ends, you may become insured again as a new Member. However, the following will apply:

1. If your AD&D Insurance ends because you cease to be a Member, and if you become a Member again within 90 days, the Eligibility Waiting Period will be waived.

2. If your AD&D Insurance ends because you are on a federal or state-mandated family or medical leave of absence, and you become a Member again immediately following the period allowed, AD&D Insurance will be reinstated pursuant to the federal or state-mandated family or medical leave act or law.

SA.RE.OT.1
CLAIMS
A. Filing A Claim
Claims should be filed on our forms. If we do not provide our forms within 15 days after they are requested, the claim may be submitted in a letter to us.

B. Time Limits On Filing Proof Of Loss
Proof Of Loss must be provided within 90 days after the date of the Loss. If that is not possible, it must be provided as soon as reasonably possible, but not later than one year after that 90-day period.

If Proof Of Loss is filed outside these time limits, the claim will be denied. These limits will not apply while the Member or Beneficiary lacks legal capacity.

C. Proof Of Loss
Proof Of Loss means written proof that a Loss occurred:

1. For which the Group Policy provides benefits;

2. Which is not subject to any exclusions; and

3. Which meets all other conditions for benefits.
9/2026 - 11 - 764999
Proof Of Loss includes any other information we may reasonably require in support of a claim. Proof Of Loss must be in writing and must be provided at the expense of the claimant. No benefits will be paid until we receive Proof Of Loss satisfactory to us.

D. Investigation Of Claim
We may have you examined at our expense at reasonable intervals. Any such examination will be conducted by specialists of our choice.

We may have an autopsy performed at our expense, except where prohibited by law.

E. Time Of Payment
We will pay benefits within 60 days after Proof Of Loss is satisfied.

F. Notice Of Decision On Claim
We will evaluate a claim for benefits promptly after we receive it. Within 90 days after we receive the claim we will send the claimant: (a) a written decision on the claim; or (b) a notice that we are extending the period to decide the claim for an additional 90 days.

If we extend the period to decide the claim, we will notify the claimant of the following: (a) the reasons for the extension; (b) when we expect to decide the claim; (c) an explanation of the standards on which entitlement to benefits is based; (d) the unresolved issues preventing a decision; and (e) any additional information we need to resolve those issues.

If we request additional information, the claimant will have 45 days to provide the information. If the claimant does not provide the requested information within 45 days, we may decide the claim based on the information we have received.

If we deny any part of the claim, we will send the claimant a written notice of denial containing:

1. The reasons for our decision.

2. Reference to the parts of the Group Policy on which our decision is based.

3. A description of any additional information needed to support the claim.

4. Information concerning the claimant's right to a review of our decision.

5. Information concerning the right to bring a civil action for benefits under section 502(a) of ERISA if the claim is denied on review.

G. Review Procedure
If all or part of a claim is denied, the claimant may request a review. The claimant must request a review in writing within 60 days after receiving notice of the denial of the claim.

The claimant may send us written comments or other items to support the claim. The claimant may review and receive copies of any non-privileged information that is relevant to the request for review. There will be no charge for such copies. Our review will include any written comments or other items the claimant submits to support the claim.

We will review the claim promptly after we receive the request. With respect to all claims, within 60 days after we receive the request for review we will send the claimant: (a) a written decision on review; or (b) a notice that we are extending the review period for 60 days.

If an extension is due to the claimant's failure to provide information necessary to decide the claim on review, the extended time period for review of the claim will not begin until the claimant provides the information or otherwise responds.

If we extend the review period, we will notify the claimant of the following: (a) the reasons for the extension; (b) when we expect to decide the claim on review; and (c) any additional information we need to decide the claim. 9/2026 - 12 - 764999
If we request additional information, the claimant will have 45 days to provide the information. If the claimant does not provide the requested information within 45 days, we may conclude our review of the claim based on the information we have received.

If we deny any part of the claim on review, the claimant will receive a written notice of denial containing:

1. The reasons for our decision.

2. Reference to the parts of the Group Policy on which our decision is based.

3. Information concerning the claimant's right to receive, free of charge, copies of non-privileged documents and records relevant to the claim.

4. Information concerning the right to bring a civil action for benefits under section 502(a) of ERISA.

The Group Policy does not provide voluntary alternative dispute resolution options. However, you may contact your local U.S. Department of Labor Office and your State insurance regulatory agency for assistance. (NO DEPS) SA.LL.OT.1

ASSIGNMENT
The rights and benefits under the Group Policy cannot be assigned.

SA.AW.OT.1

BENEFIT PAYMENT AND BENEFICIARY PROVISIONS
A. Payment Of Benefits
AD&D Insurance Benefits payable because of Loss of your life will be paid to the Beneficiary you name. See B through E of this section.

AD&D Insurance Benefits payable for Losses other than Loss of life will be paid to the person who incurred the Loss for which the benefits are payable. Any such benefits remaining unpaid at that person's death will be paid according to the provisions for payment of a death benefit.

Additional Benefits will be paid as follows:

The Career Adjustment Benefit will be paid to your surviving Spouse. No Career Adjustment Benefit will be paid if you have no surviving Spouse.

The Child Care Benefit will be paid to your surviving Spouse. No Child Care Benefit will be paid if you have no surviving Spouse.

The Higher Education Benefit will be paid annually to each eligible Child. No Higher Education Benefit will be paid if there is no Child eligible to receive it.

The Repatriation Benefit will be paid to the person who incurs the transportation expenses.

B. Naming A Beneficiary
Beneficiary means a person you name to receive death benefits. You may name one or more Beneficiaries.

If you name two or more Beneficiaries in a class:

1. Two or more surviving Beneficiaries will share equally, unless you provide for unequal shares.

2. If you provide for unequal shares in a class, and two or more Beneficiaries in that class survive, we will pay each surviving Beneficiary his or her designated share. Unless you provide otherwise, we will then pay the share(s) otherwise due to any deceased Beneficiary(ies) to the surviving Beneficiaries pro rata based on the relationship that the designated percentage or fractional share of each surviving Beneficiary bears to the total shares of all surviving Beneficiaries.
9/2026 - 13 - 764999

3. If only one Beneficiary in a class survives, we will pay the total death benefits to that Beneficiary.

You may name or change Beneficiaries at any time without the consent of a Beneficiary.

You may name or change Beneficiaries in writing. Writing includes a form signed by you, or a verification from us or our designated agent, the Policyholder or the Policyholder’s designated agent, or the Employer or the Employer’s designated agent of an electronic or telephonic designation made by you.

Your designation:

1. Must be dated;

2. Must be delivered to us or our designated agent, the Policyholder or the Policyholder’s designated agent, or the Employer or the Employer’s designated agent, during your lifetime;

3. Must relate to the AD&D Insurance provided under the Group Policy; and

4. Will take effect on the date it is delivered to or, if a telephonic or electronic designation, verified by us or our designated agent, the Policyholder or the Policyholder’s designated agent, or the Employer or the Employer’s designated agent.

If we approve it, a designation, which meets the requirements of a Prior Plan will be accepted as your Beneficiary designation under the Group Policy.

C. Simultaneous Death Provision
If a Beneficiary or a person in one of the classes listed in item D. No Surviving Beneficiary dies on the same day you die, or within 15 days thereafter, benefits will be paid as if that Beneficiary or person had died before you, unless Proof Of Loss with respect to your death is delivered to us before the date of the Beneficiary's death.

D. No Surviving Beneficiary
If you do not name a Beneficiary, or if you are not survived by one, benefits will be paid in equal shares to the first surviving class of the classes below.

1. Your Spouse. (See Definitions)

2. Your children.

3. Your parents.

4. Your brothers and sisters.

5. Your estate.

E. Methods Of Payment
Recipient means a person who is entitled to benefits under this Benefit Payment and Beneficiary Provisions section.

1. Lump Sum
If the amount payable to a Recipient is less than $25,000, we will pay it in a lump sum.

2. Standard Secure Access Checking Account
If the amount payable to a Recipient is $25,000, or more, we will deposit it into a Standard Secure Access checking account which:
a. Bears interest at a rate equal to the 13-week Treasury Bill (T-Bill) auction rate, but not to exceed 5%; b. Is owned by the Recipient;
c. Is subject to the terms and conditions of a confirmation certificate which will be given to the Recipient; and d. Is fully guaranteed by us.
9/2026 - 14 - 764999

3. Installments
Payment to a Recipient may be made in installments if:
a. The amount payable is $25,000 or more;
b. The Recipient chooses; and
c. We agree.

To the extent permitted by law, the amount payable to the Recipient will not be subject to any legal process or to the claims of any creditor or creditor's representative. (ELECT/TEL DESIG_THIRD PARTY DESIG) SA.BB.CA.1

TIME LIMITS ON LEGAL ACTIONS
No action at law or in equity may be brought until 60 days after we have been given Proof Of Loss. No such action may be brought more than three years after the earlier of:

1. The date we receive Proof Of Loss; and

2. The time within which Proof Of Loss is required to be given.

SA.TL.OT.1

INCONTESTABILITY PROVISIONS
A. Incontestability Of Insurance
Any statement made to obtain or to increase insurance under the Group Policy is a representation and not a warranty.

No misrepresentation will be used to reduce or deny a claim unless:

1. The insurance would not have been approved if we had known the truth; and

2. We have given you or any other person claiming benefits a copy of the signed written instrument which contains the misrepresentation.

We will not use a misrepresentation to reduce or deny a claim after the insurance under the Group Policy, for which such representation was made, has been in effect for two years, unless it was a fraudulent misrepresentation.

B. Incontestability Of Group Policy
Any statement made by the Policyholder to obtain the Group Policy is a representation and not a warranty.

No misrepresentation by the Policyholder will be used to deny a claim or to deny the validity of the Group Policy unless:

1. The Group Policy would not have been issued if we had known the truth; and

2. We have given the Policyholder a copy of a written instrument signed by the Policyholder which contains the misrepresentation.

The validity of the Group Policy will not be contested after it has been in force for two years, except for:

1. Nonpayment of premiums; or

2. Fraudulent misrepresentations.

SA.IN.OT.1
9/2026 - 15 - 764999

CLERICAL ERROR, AGENCY, AND MISSTATEMENT
A. Clerical Error
Clerical error by the Policyholder, your Employer, or their respective employees or representatives will not:

1. Cause a person to become insured;

2. Invalidate insurance under the Group Policy otherwise validly in force; or

3. Continue insurance under the Group Policy otherwise validly terminated.

B. Agency
The Policyholder and your Employer act on their own behalf as your agent, and not as our agent. The Policyholder and your Employer have no authority to alter, expand or extend our liability or to waive, modify or compromise any defense or right we may have under the Group Policy.

C. Misstatement Of Age
If a person's age has been misstated, we will make an equitable adjustment of premiums, benefits, or both. The adjustment will be based on:

1. The amount of insurance based on the correct age; and

2. The difference between the premiums paid and the premiums which would have been paid if the age had been correctly stated.

SA.CE.OT.1

TERMINATION OR AMENDMENT OF THE GROUP POLICY
The Group Policy may be terminated by us or the Policyholder according to its terms. It will terminate automatically for nonpayment of premium. The Policyholder may terminate the Group Policy in whole, and may terminate insurance for any class or group of Members, at any time by giving us written notice.

Benefits under the Group Policy are limited to its terms, including any valid amendment. No change or amendment will be valid unless it is approved in writing by one of our executive officers and given to the Policyholder for attachment to the Group Policy. The Policyholder, your Employer, and their respective employees or representatives have no right or authority to change or amend the Group Policy or to waive any of its terms or provisions without our signed written approval.

We may change the Group Policy in whole or in part when any change or clarification in law or governmental regulation affects our obligations under the Group Policy, or with the Policyholder's consent.

Any such change or amendment of the Group Policy may apply to current or future Members or to any separate classes or groups thereof.

SA.TA.OT.1

DEFINITIONS
Annual Earnings means your annual rate of earnings from your Employer. Your Annual Earnings will be based on your earnings in effect on your last full day of Active Work unless a different date applies (see the Coverage Features).

Annual Earnings includes:

1. Contributions you make through a salary reduction agreement with your Employer to:
a. An Internal Revenue Code (IRC) Section 401(k), 403(b), 408(k), or 457 deferred compensation arrangement; or
b. An executive nonqualified deferred compensation arrangement. 9/2026 - 16 - 764999

2. Shift differential pay.

3. Amounts contributed to your fringe benefits according to a salary reduction agreement under an IRC Section 125 plan.

Annual Earnings does not include:

1. Bonuses.

2. Commissions.

3. Overtime pay.

4. Stock options or stock bonuses.

5. Your Employer's contributions on your behalf to any deferred compensation arrangement or pension plan.

6. Any other extra compensation.

Child means:

1. Your child from live birth through age 25; or

2. Your Disabled child who is continuously incapable of self-sustaining employment because of mental or physical handicap; and chiefly dependent upon you for support and maintenance or institutionalized because of mental or physical handicap.

Child includes any of the following, if they otherwise meet the definition of Child:
i. Your adopted child; or
ii. Your stepchild or child of your Spouse, if living in your home.

Contributory means you pay all or part of the premium for insurance.

Eligibility Waiting Period means the period you must be a Member before you become eligible for AD&D Insurance. See Coverage Features.

Group Policy means the group accidental death and dismemberment insurance policy issued by us to the Policyholder and identified by the Group Policy Number.

Injury means an injury to your body.

L.L.C. Owner-Employee means an individual who owns an equity interest in an Employer and is actively employed in the conduct of the Employer's business.

Noncontributory means the Policyholder pays the entire premium for insurance.

P.C. Partner means the sole active employee and majority shareholder of a professional corporation in partnership with the Policyholder.

Physician means a licensed M.D. or D.O. acting within the scope of the license. Physician does not include you or your Spouse, or the brother, sister, parent or child of either you or your Spouse.

Pregnancy means the pregnancy, childbirth, or related medical conditions, including complications of pregnancy.

Prior Plan means your Employer's group accidental death and dismemberment insurance plan in effect on the day before the effective date of your Employer's coverage under the Group Policy and which is replaced by the Group Policy.

Sickness means your sickness, illness, or disease.

Spouse means:

1. A person to whom you are legally married; or

2. Your Domestic Partner. Your Domestic Partner means an individual recognized as such under California state law.
9/2026 - 17 - 764999
For purposes of insurance under the Group Policy, Spouse does not include a person who is eligible for AD&D Insurance as a Member or a person who is a full-time member of the armed forces of any country or a person from whom you are divorced or from whom you have terminated a Domestic Partner relationship. (DOM_STAT_REG NO COM) SA.DF.CA.1

POLICYHOLDER PROVISIONS
A. Premiums
The premium due on each Premium Due Date is the sum of the premiums for all persons then insured. Premium Rates are shown in the Coverage Features.

B. Contributions From Members
The Policyholder determines the amount, if any, of each Member's contribution toward the cost of insurance under the Group Policy.

C. Changes In Premium Rates
We may change Premium Rates when:

1. A change or clarification in law or governmental regulation affects the amount payable under the Group Policy.

Any such change in Premium Rates will reflect only the change in our obligations; or

2. We and the Policyholder mutually agree to change Premium Rates, or

3. Factors material to underwriting the risk we assumed under the Group Policy, including, but not limited to, number of persons insured, age, Annual Earnings, gender and occupational classification, change by 25% or more.

Except as provided above, Premium Rates will not be changed during the Initial Rate Guarantee Period shown in the Coverage Features. Thereafter, except as provided above, we may change Premium Rates upon advance written notice to the Policyholder. The minimum advance notice is shown in the Coverage Features as Notice of Rate Change. Any such change in Premium Rates may be made effective on any Premium Due Date, but no such change will be made more than once in any contract year. Contract years are successive 12 month periods computed from the end of the Initial Rate Guarantee Period.

D. Payment Of Premiums
All premiums are due on the Premium Due Dates shown in the Coverage Features.

Each premium is payable on or before its Premium Due Date directly to us at our home office. The payment of each premium as it becomes due will maintain the Group Policy in force until the next Premium Due Date.

E. Grace Period And Termination For Nonpayment
If a premium is not paid on or before its Premium Due Date, it may be paid during the following Grace Period. The length of the Grace Period is shown in the Coverage Features. The Group Policy will remain in force during the Grace Period.

If the premium is not paid during the Grace Period, the Group Policy will terminate automatically at the end of the Grace Period.

The Policyholder is liable for premium for insurance under the Group Policy during the Grace Period. We may charge interest at the legal rate for any premium which is not paid during the Grace Period, beginning with the first day after the Grace Period.

F. Termination For Other Reasons
9/2026 - 18 - 764999
The Policyholder may terminate the Group Policy by giving us written notice. The effective date of termination will be the later of:

1. The date stated in the notice; and

2. The date we receive the notice.

We may terminate the Group Policy as follows:

1. On any Premium Due Date if the number of persons insured is less than the Minimum Participation Number or less than the Minimum Participation Percentage shown in the Coverage Features.

2. On any Premium Due Date if we determine that the Policyholder has failed to promptly furnish any necessary information requested by us, or has failed to perform any other obligations relating to the Group Policy.

The minimum advance notice of such termination by us is the same as the Notice of Rate Change stated in the Coverage Features.

G. Premium Adjustments
Premium adjustments involving a return of unearned premiums to the Policyholder will be limited to the 12 months just before the date we receive a request for premium adjustment.

H. Certificates
We will issue certificates to the Policyholder showing the coverage under the Group Policy. The Policyholder will distribute a certificate to each insured Member.

If the terms of the Certificate differ from the Group Policy, the terms stated in the Group Policy will govern.

I. Records And Reports
The Policyholder will furnish on our forms all information reasonably necessary to administer the Group Policy.

We have the right at all reasonable times to inspect the payroll and other records of the Policyholder which relate to insurance under the Group Policy.

J. Agency And Release
Individuals selected by the Policyholder or by any Employer to secure coverage under the Group Policy or to perform their administrative function under it, represent and act on behalf of the person selecting them, and do not represent or act on behalf of Standard Insurance Company. The Policyholder, Employer and such individuals have no authority to alter, expand or extend our liability or to waive, modify or compromise any defense or right we may have under the Group Policy. The Policyholder and each Employer hereby release, hold harmless and indemnify Standard Insurance Company from any liability arising from or related to any negligence, error, omission, misrepresentation or dishonesty of any of them or their representatives, agency or employees.

K. Notice Of Suit
The Policyholder or Employer shall promptly give us written notice of any lawsuit or other legal proceedings arising under the Group Policy.

L. Entire Contract, Changes
The Group Policy and the application of the Policyholder constitute the entire contract between the parties. A copy of the Policyholder's application is attached to the Group Policy when issued.

The Group Policy may be changed in whole or in part. No change in the Group Policy will be valid unless it is approved in writing by one of our executive officers and given to the Policyholder for attachment to the Group Policy. No agent has authority to change the Group Policy or to waive any of its provisions.

M. Effect On Workers' Compensation, State Disability Insurance 9/2026 - 19 - 764999
The coverage provided under the Group Policy is not a substitute for coverage under a workers' compensation or state disability income benefit law and does not relieve the Employer of any obligation to provide such coverage.

SA.PH.OT.1
AD2010P
Standard Insurance Company Service Agreement No. 764999 Life Notification Service Agreement Page 1 of 3 Issued 9/2026

STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282

MEMBER NOTIFICATION SERVICE AGREEMENT
Client: City of Anaheim
Group Life Insurance Policy Number(s): 764999
Master Agreement Number: 764999
Service Agreement Number: 764999
Service Agreement Effective Date: January 1, 2027
This Service Agreement is made part of the above referenced Master Agreement between Standard Insurance Company (Standard) and Client.

1. Member Notification Services.

A. Group Policy means the group life insurance policy that Standard issued to Client as Policyholder under the Group Insurance Policy Number shown above.

B. Standard shall provide administrative services for notification of group life insurance portability and group life insurance conversion under the terms of the Group Policy. These services consist of sending notification on behalf of Client to Members included on Client’s data feed except as noted in Section 4 below regarding potential eligibility to apply for group life insurance portability and group life insurance conversion under the Group Policy.

2. Client's Obligations.

A. Client obligations shall consist of:
(1) Providing data transfers as shown in Exhibit 1, Eligibility Feed Specifications, to Standard on a bi-weekly basis.
(2) Establishing the technologies, standards and use-cases, satisfactory to Standard, which ensure that Client’s technology information systems are capable of securely and accurately completing the data transfers described in Exhibit 1.
(3) Employing an implementation of the technologies, standards and use-cases supported by Standard, which serve to enable the transfer of data between Standard's technology information systems and Client's technology information systems, and install any software on its systems that may be required to accomplish this.
a. Bear all its own costs and expenses in connection with the performance of its obligations described in

2.A.(2) and (3);
b. Provide technical and administrative contact information as necessary to facilitate contact by Standard;
c. Apply industry best practices in securing its information technology systems, including promptly applying relevant security patches to systems;
d. Act in a manner that complies with federal, state or local laws and rules; Standard Insurance Company Service Agreement No. 764999 Life Notification Service Agreement Page 2 of 3 Issued 9/2026 e. Maintain industry standard policies and standards for (i) defining the attributes required to access its information technology systems (ii) protection of personal information of insured members and (iii) ensuring that personal information is protected from access requests by unauthorized parties. (4) Client is solely responsible for securing access to its transmission facilities or equipment and securing access to or preventing alteration, delay, theft or destruction of its (or its end users') data file, programs, procedures or other information.
(5) Client agrees that any Client information technology systems may cache temporarily credentials that are supplied by it for operational efficiency or sequential, repeated authentication purposes within a given session or reasonable length episode. Any shared attributes/credentials will not be used for any purpose or intent, and such credentials will be destroyed at the end of the session or episode in which they are needed. With the exception of anonymous attributes, such shared attributes/credentials will not be stored permanently.
(6) Standard may, at its own expense, and upon reasonable notice, review or audit Client data files, file specifications, transmission processes, and related information provided to Standard under this Service Agreement to determine if Client is in compliance with this Service Agreement. Client shall cooperate with Standard in the conduct of such review or audit.
(7) Furnishing any information reasonably required by Standard to carry out its duties under this Service Agreement.

3. Fees and Payment.

A. The fee is included in the premium charge for Group Life Insurance Policy Number 764999.

B. Standard may change the amount, the method of determination, or both, of any fees not yet due, when a change in any law or regulation affects the manner in which Standard performs any function under this Service Agreement. The amount, the method of determination, or both, of any fees not yet due may also be changed upon mutual agreement between Client and Standard.

C. Standard may change the amount, the method of determination, or both, of any fees not yet due, upon 60 days written notice to Client. No such change in fees shall be made more than once in any calendar year, provided that this limitation shall not apply to any changes in fees in connection with any change in the terms of this Service Agreement, or the Group Policy or changes in laws.

D. All fees are due and payable in accordance with the provisions of the Group Policy.

4. Disclaimer.

A. Standard will not provide group life insurance portability or group life insurance conversion notifications if the Member’s insurance ended more than 60 days prior to Standard’s receipt of Client’s data feed.

B. Standard will not provide group life insurance portability or group life insurance conversion notifications to Members living outside the United States or Canada.

C. Standard will not provide group life insurance conversion notification when loss of coverage is due to failure to pay premiums.

D. Standard will not provide group life insurance conversion notification when coverage is reduced due to a change in the Member’s classification.

E. Standard will not provide group life insurance conversion notification to spouse and/or child dependents.

F. Standard has not and will not provide legal advice, opinions or other legal services to Client relative to this Service Agreement. Client will rely solely upon the advice of its own legal counsel in evaluating the legal aspects of the Group Policy and the Service Agreement.

Standard Insurance Company Service Agreement No. 764999 Life Notification Service Agreement Page 3 of 3 Issued 9/2026 G. Standard shall not be considered to have failed to perform its obligations under this Service Agreement if any delay or nonperformance on its part is due, in whole or in part, to Client's failure to discharge its own obligations promptly.

H. After the termination of this Service Agreement, Standard shall have no further obligation of any nature or kind for providing notifications.

5. Records.

Any records, reports and other information prepared and maintained by Standard pursuant to this Service Agreement may be destroyed by Standard in accordance with its normal document retention and destruction policies.

6. Notices.

Standard will not be bound by any notice, direction, requisition, or request unless and until received in writing at Standard's home office as may be described in Section 17 of the agreement between Standard and the City.

7. Termination.

Client will provide Standard with 60 days advance notice of policy termination. This Service Agreement will terminate automatically on the date the last Group Policy terminates.

The parties are signing this Service Agreement on the dates indicated below.

STANDARD INSURANCE COMPANY CITY OF ANAHEIM
By:

Date: September 2026
By:

Name:
(Please print)
Title:

Date:

Standard Insurance Company
ADA Accommodation Services Page 1 of 4 Issued 9/2026

STANDARD INSURANCE COMPANY
A Stock Life Insurance Company 900
SW Fifth Avenue
Portland, Oregon 97204-1282

ADA ACCOMMODATION SERVICES SERVICE AGREEMENT
Client: City Of Anaheim
Master Agreement Number: 764999
ADA Accommodation Services Service Agreement Number: 764999 ADA Accommodation Services Service Agreement Effective
Date:

January 1, 2027
This ADA Accommodation Services Service Agreement (“Service Agreement”) is made part of the above referenced Master Agreement and the City’s agreement between Standard Insurance Company ("The Standard") and Client.

1. ADA Accommodation Services. The Standard will provide ADA Accommodation Services (“Services”) not covered by Client’s group disability insurance policy to Client’s total eligible population (i.e., qualified individuals with disabilities, including applicants for employment and employees) to assist Client with its compliance obligations under the Americans with Disabilities Act Amendments Act of 2008 (“ADAAA”) as follows:

A. Upon referral to The Standard’s accommodation specialist by either The Standard’s Absence Management service, or by Client pursuant to 1B below, the accommodation specialist will:
(1) Receive notification of employees exhausting continuous FMLA leave, or are ineligible for continuous FMLA leave for their own medical condition from internal Leave of Absence “LOA” reports and contact those employees;
(2) Review current medical information and, if needed, contact treating medical provider(s) to obtain medical prognosis and/or clarify work restrictions;
(3) Support the interactive process by engaging with the employee and Client to identify specific accommodation needs and provide recommendations for workplace accommodations, including education to Client regarding any factors that may affect the suitability of proposed accommodations. The Standard and Client agree that Client will be the final decision maker as to the reasonableness of any potential accommodation identified by the Services; and
(4) If accommodation is approved by Client, contact employee and confirm accommodation and/or Return to Work plan and send notification to Client and employee. (5) The Standard will not provide services for employees outside the scope of the ADAAA (e.g., pregnancy itself is not a disability under the ADAAA; however, pregnant workers may have impairments related to their pregnancies that qualify as disabilities under the ADAAA that would be evaluated accordingly); the federal Pregnant Workers Fairness Act (PWFA) is outside the scope of the ADA Accommodation Service Agreement.

B. For Client’s eligible population, Client may request Services for cases The Standard has not reviewed through The Standard’s Absence Management service.

Standard Insurance Company
ADA Accommodation Services Page 2 of 4 Issued 9/2026

2. Types of Services. The following is a description of the Services that The Standard will provide:

A. Communication with employee, Client, and employee’s treating medical provider(s) (as permitted and appropriate) to understand and document employee’s work restrictions and limitations; B. Review of job accommodation requests (if applicable) and presentation of accommodation options and recommendations for Client’s review that fit within employee’s work restrictions and limitations for the purposes of enabling employee to perform the essential functions of the employee’s position; C. Procurement and/or implementation of Client-approved accommodation and written documentation of the decision-making process; and
D. Follow up with Client and/or employee to ensure accommodation continues to meet employee’s needs.

3. Client’s Obligations.

A. Client shall:
(1) Provide The Standard in writing with accurate and updated contact information for all individuals authorized to act for Client in connection with this Service Agreement, together with a statement of the extent of their authority;
(2) Promptly furnish any information reasonably required by The Standard to carry out its duties under this Service Agreement, including accurate and updated demographic and employment information on Client’s total eligible population; and
(3) Promptly reply to The Standard’s requests to review and/or approve accommodation options and recommendations to ensure timely communication with employees.

B. The Standard shall not be considered to have failed to perform its obligations under this Service Agreement if any delay or nonperformance on its part is due, in whole or in part, to Client's failure to discharge its own obligations promptly including Client’s failure to provide correct, accurate and complete LOA data or any other necessary employee data.

4. Fees and Payment.

A. For Client’s employees insured under Client’s group disability insurance policy with The Standard, the fees for services described in this Service Agreement are $0.85 per employee per month.

B. For Client’s applicants or employees not insured under Client’s group disability insurance policy with The Standard, the fee for service described in this Service Agreement are $0.85 per employee per month.

C. For takeover case a fee of $150.00 per case will be applied, to a maximum of $7,500.

D. Upon mutual agreement by both parties, for individual cases where parties agree that an employee is not covered under the ADAAA, the employer may refer those cases for a fee of $750.00 per case. The same Services outlined in sections 1 and 2 will be provided, excluding internal report review.

E. The Standard may change the amount, the method of determination, or both, of any fees not yet due, when a change in any law or regulation affects the manner in which The Standard performs any function under this Service Agreement or other factors impact the case volume.

Except as provided above, the fees will not be changed during the Initial Rate Guarantee Period of January 1, 2027, to January 1, 2030. The Standard will provide Client with one hundred eighty (180) days’ notice prior to any such change. No such change in fees shall be made more than once in any calendar year.

F. All fees are due and payable within 60 days of receipt of invoice. The Standard may suspend any services hereunder that remain unpaid after 60 days from Client’s receipt of invoice.

Standard Insurance Company
ADA Accommodation Services Page 3 of 4 Issued 9/2026
G. Furniture and equipment costs are not included in the fees. The Standard will procure furniture and equipment with Client’s approval then invoice Client for the furniture and equipment. The Standard may also charge Client for associated shipping and installation costs.

5. Affiliates Covered by this Service Agreement.

A. For the purposes of this Service Agreement, "Client" includes any applicable affiliates as agreed upon by the parties.

B. Client warrants that it has the authority to enter into this Service Agreement on behalf of any affiliates.

C. Administration for other entities identified under this section that require additional processes may result in additional charges or costs that will need to be mutually agreed upon by Standard and Client prior to commencement of administration.

6. Disclaimer.

The Standard provides administrative, informational and referral type services through its employees and consultants. The Standard does not provide health insurance or medical services, nor does it recommend treatment.

Specifically, with respect to the Services, when assisting Client with its compliance obligations, The Standard utilizes its vocational expertise and experience providing return to work and stay at work services to a broad range of employers across the country. Client acknowledges that the individuals providing Services are not attorneys and that The Standard does not provide any legal advice to Client. Client retains ultimate responsibility for determining whether an accommodation is required, whether an accommodation will be made, and/or the nature of that accommodation and whether any particular accommodation is suitable for an employee. Client may not rely on the Services to ensure its compliance with the ADAAA. The Standard specifically assumes no responsibility or liability for Client’s ADAAA compliance.

7. Additional Services.

In the event that Client desires that The Standard perform consulting or other services related to the Services not otherwise outlined in this Service Agreement, and if The Standard agrees to provide such additional services, then The Standard and Client will agree on the rate to be charged by The Standard for performance of additional services prior to the commencement of any additional work.

8. Record Ownership.

All documents, records, reports and data stored in The Standard's possession relating to the administration of the Services shall at all times be considered the property of Client, subject to the following:

A. The Standard's right to possession during the continuance of this Service Agreement.

B. Records obtained for the purpose of investigating and administering disability claims under The Standard's insurance policies are owned by The Standard and shall be retained pursuant to applicable laws and The Standard's records retention policy.

9. Termination. This Service Agreement may be terminated as follows:

A. Without Cause. Either party may terminate this Service Agreement by providing the other party at least 60 days prior written notice.

B. Default. Either party may terminate this Service Agreement if the other party breaches or is in default of any obligation of this Service Agreement, which default is incapable of cure or which, being capable of cure, has not been cured within 10 days after receipt of written notice (or within such additional cure period as the nondefaulting party may authorize).

10. Change to Service Agreement.

The terms of the Services are governed under the Master Agreement and this Service Agreement. The Service Agreement may be changed in whole or in part. No change in the Service Agreement will be valid unless it is Standard Insurance Company
ADA Accommodation Services Page 4 of 4 Issued 9/2026
approved in writing and signed by both The Standard and the Client. Client and The Standard represent and warrant that signers to any changes are authorized to accept changes to the Service Agreement.

The parties are signing this Service Agreement on the dates indicated below.

STANDARD INSURANCE COMPANY
By:

Dan McMillan
President and CEO
Date: September 2026

CITY OF ANAHEIM
By:

Name:
(Please print)
Title:

Date: