Heidelberg University

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The Guardian Life Insurance Company of America, New York, NY 10004

Group Number: 482733

Heidelberg University

All employees

Here you'll find information about your following employee benefit(s). Be sure to review the

enclosed - it provides everything you need to sign up for your Guardian benefits.

PLAN HIGHLIGHTS

• Disability

• Critical Illness

• Accident

Questions? Concerns?

Helpline (888) 600-1600

Call weekdays, 7:00 AM to 8:30 PM, EST.

And refer to your plan number: 482733

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The Guardian Life Insurance Company of America, New York, NY 10004

Welcome

Dear Heidelberg University Employee,

We’re pleased to tell you that Guardian will be our coverage provider this year. We

have chosen Guardian because of its competitive rates, excellent service reputation, and

extensive plan designs.

Margaret Rudolph

Director HR

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About Your Benefits:

Your paycheck is your greatest asset. How else would you pay for expenses like your rent or mortgage, food and transportation?

Disability insurance helps replace lost income if you have an accident or illness that prevents you from working. Unfortunately,

disabilities occur more often than you may think. Be prepared and take advantage of an opportunity to help protect your financial

well being. Enroll today!

What Your Benefits Cover:

Heidelberg University

Heidelberg University All employees Benefit Summary

The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

Short-Term Disability Benefit Summary

Effective: March 01, 2014

Group Number: 482733

Short-Term Disability

.

Coverage amount Choose weekly benefit amount from $200 to $1300. See cost illustration page for weekly benefit offerings.

Maximum payment period: Maximum length of time you can

receive disability benefits. 26 weeks Accident benefits begin: The length of time you must be disabled

before benefits begin. Day 8

Illness benefits begin: The length of time you must be disabled

before benefits begin. Day 8

Evidence of Insurability: A health statement requiring you to

answer a few medical history questions. Health Statement may be required Guarantee Issue: The ‘guarantee’ means you are not required to

answer health questions to qualify for coverage up to and including the specified amount, when applicant signs up for coverage during the initial enrollment period.

We Guarantee Issue $1300 in coverage

Minimum work hours/week: Minimum number of hours you must

regularly work each week to be eligible for coverage. Planholder Determines

Pre-existing conditions: A pre-existing condition includes any condition/symptom for which you, in the specified time period prior to coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs.

3 months look back; 12 months after 2 week limitation

Premium waived if disabled: Premium will not need to be paid

when you are receiving benefits. Yes

UNDERSTANDING YOUR BENEFITS—DISABILITY (Some information may vary by state)

l

Earnings definition: Your covered salary excludes bonuses and commissions.

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Short-Term Disability Plan Semi-monthly Cost Illustration:

To determine the most appropriate level of coverage, you should consider your current basic monthly expenses. To help you assess

your needs, you can also go to Guardian Anytime and use our Disability Insurance Explorer Tool.

Heidelberg University All employees Benefit Summary

The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

Election Cost Per Age Bracket

< 25 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60+

$17,333 Minimum Annual Salary

$200 Weekly Benefit $10.42 $10.42 $9.84 $7.50 $7.04 $7.07 $8.05 $10.47 $12.77 $21,667 Minimum Annual Salary

$250 $13.03 $13.03 $12.30 $9.38 $8.80 $8.84 $10.06 $13.09 $15.96 $26,000 Minimum Annual Salary

$1,000 $52.10 $52.10 $49.20 $37.50 $35.20 $35.35 $40.25 $52.35 $63.85 $95,333 Minimum Annual Salary

$1,300 $67.73 $67.73 $63.96 $48.75 $45.76 $45.96 $52.33 $68.06 $83.01

*This benefit may not exceed 60% of your weekly salary.

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Heidelberg University All employees Benefit Summary

The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

Manage Your Benefits:

Questions?

Enrolled members and their dependents can access

helpful, secure information about their Guardian benefits at

www.guardiananytime.com

Call the Guardian Helpline (888) 600-1600

Call weekdays, 7:00 AM to 8:30 PM, EST. And refer

to your plan number : 482733

A SUMMARY OF DISABILITY PLAN LIMITATIONS

AND EXCLUSIONS

n Evidence of Insurability is required on all late enrollees. This coverage will not be effective until approved by a Guardian underwriter. This proposal is hedged subject to satisfactory financial evaluation. Please refer to certificate of coverage for full plan description.

n You must be working full-time on the effective date of your coverage; otherwise, your coverage becomes effective after you have completed a specific waiting period.

n Employees must be legally working in the United States in order to be eligible for coverage. Underwriting must approve coverage for employees on temporary assignment: (a) exceeding one year; or (b) in an area under travel warning by the US Department of State. Subject to state specific variations.

n For Short-Term Disability coverage, benefits for a disability caused or contributed to by a pre-existing condition are limited, unless the disability starts after you have been insured under this plan for a specified period of time. We do not pay short term disability benefits for any job-related or on-the-job injury, or conditions for which Workers' Compensation benefits are payable.

n We do not pay benefits for charges relating to a covered person: taking part in any war or act of war (including service in the armed forces) committing a felony or taking part in any riot or other civil disorder or intentionally injuring themselves or attempting suicide while sane or insane. We do not pay benefits for charges relating to legal intoxication, including but not

limited to the operation of a motor vehicle, and for the voluntary use of any poison, chemical, prescription or non-prescription drug or controlled substance unless it has been prescribed by a doctor and is used as prescribed. We limit the duration of payments for long term disabilities caused by mental or emotional conditions, or alcohol or drug abuse. We do not pay benefits during any period in which a covered person is confined to a correctional facility, an employee is not under the care of a doctor, an employee is receiving treatment outside of the US or Canada, and the employee’s loss of earnings is not solely due to disability.

n This policy provides disability income insurance only. It does not provide "basic hospital", "basic medical", or "medical" insurance as defined by the New York State Insurance Department.

n If this plan is transferred from another insurance carrier, the time an insured is covered under that plan will count toward satisfying Guardian's

pre-existing condition limitation period. State variations may apply.

n When applicable, this coverage will integrate with NJ TDB, NY DBL, CA SDI, RI TDI, Hawaii TDI and Puerto Rico DBA.

Contract #.s GP-1-STD94-1.0 et al; GP-1-STD2K-1.0 et al; , GP-1-STD07-1.0 et al.

This handout is for illustration purposes only and is an approximation, premium amounts may be amended.

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Protecting Your Greatest Asset – Your Ability to

Earn an Income

Did You Know?

• Three in 10 workers entering the workforce will become disabled before retiring.(1)

• A disabling injury occurs every three seconds in a public setting and every four seconds in the

home.(2 )

• Nearly half of U.S. employees would discontinue contributions to their retirement accounts in the

event of an illness or disability.(3)

• Disability protection provides income replacement for employees who are unable to work due to

accident or illness.

Statistics show that there’s a good possibility you may become disabled during your lifetime. And with 71% of

Americans living paycheck to paycheck(4), time away from work due to illness or injury can be financially

devastating for many families. That’s because the ability to earn a living is the most significant financial asset most

workers have. You can protect that asset through disability income insurance, which replaces a percentage of

pre-disability income for a specified period of time.

Quick Tips About Buying Disability Protection

• Your workplace is a good place to start: If your employer offers a disability product, consider

enrolling in it. Your employer has done all the work of finding a quality plan, and a workplace benefit

is generally affordable (just a few dollars a month in many cases) and easy to buy. Moreover, you

don’t typically need a medical exam to enroll.

• Having the right amount of protection is important: Everyone’s needs vary. Monthly expenses,

personal savings, and other sources of income should be carefully considered when trying to

determine how much income is necessary to maintain your lifestyle. You may need supplemental

coverage to ensure that you are adequately protected.

• Plan ahead: Visit

www.disabilitycanhappen.org

and take the “5 questions every worker should ask”

quiz to help understand how prepared you are. It’s also a good idea to complete the income and

expense review and develop an action plan. These tools can help you take responsible action should

the unthinkable happen.

Better Information Leads to Better Choices.

At Guardian, we maintain a strong commitment to enriching the lives of the people we touch. In fact, our benefits

are just the beginning. We are committed to providing industry-leading service and support to ensure that every

customer is satisfied and prepared to make the best possible decisions about their lives, their finances, and their

benefits.

1. Social Security Administration, Fact Sheet 2007. 2. National Safety Council, “Injury Facts”, 2007

3. Guardian Insurance and Behavior—Spotlight on IDI Survey, 2006 4. American Payroll Association, “Getting Paid in America” Survey, 2008

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Short Term Disability Cost Worksheet

Step 1 – Calculate Benefit

Example: Assumes Annual Salary = $60,000 Benefit % = 60%, Maximum Benefit = $1000

Column A Column B Column C Column D

Annual Salary ÷ 52 = Weekly Salary

Benefit % x Weekly Salary = Weekly

Benefit

Does the Weekly Benefit (Column B) exceed the Maximum Benefit in the

Example

Weekly Benefit If No, Enter Calculated Weekly Benefit

(Column B)

If Yes, use the Maximum Benefit $60,000 ÷ 52 =

$1,154 60% x 1,154 = $692 No $692

Calculate your weekly benefit below:

YOU: Your weekly benefit

is

Step 2 - Calculate Cost:

To determine your total cost per pay, follow the steps outlined in the example below.

• Please refer to the Short Term Disability Premium Illustration Page to capture the appropriate rate.

• Examples of pay frequency: Semi-Monthly -24 pay periods, Bi-Weekly – 26 pay periods, Weekly – 52 pay periods,

Monthly 12 pay periods

Example: Assumes 24 Pay Periods

Rate Find your rate on the STD Cost Illustration Page Weekly Benefit (Step 1 Column D) Rate x Weekly Benefit Divide by 10 = Monthly Cost Multiply by 12 = Annual Cost Divide by Pay Frequency = Cost per Pay Period

“Sample Rate” .33 $1000 .33 x $692 = $228.36 $228.36 ÷ 10 = $22.84 $22.84 x 12 = $274.08 $274.08 ÷ 24 = $11.42 Calculate your cost per pay period below:

YOU: Find your rate on the STD Cost Illustration Page

My rate is

Important information about your Short Term Disability plan: We do not pay benefits for charges relating to a covered person: taking part in any war or act of war (including

service in the armed forces); committing a felony or taking part in any riot or other civil disorder; or intentionally injuring themselves or attempting suicide while sane or insane. We do not pay benefits during any period in which a covered person is confined to a correctional facility, an employee is not under the care of a doctor, and the employee’s loss or earnings is not solely due to disability. We do not pay benefits for any job-related or on-the-job injury, or conditions for which Workers' Compensation benefits are payable. This policy provides disability income insurance only. It does not provide “basic hospital,” “basic medical,” “major medical” insurance as defined by the New York State Insurance Department. Employees must be legally working in the United States in order to be eligible for coverage. Underwriting must approve coverage for employees on temporary assignment: (a) exceeding 1 year; or (b) in an area under travel warning by the US Department of State, subject to state specific variations.

This handout is for illustrative purposes only and is an approximation. If any discrepancies between this handout and your paycheck stub exist, your paycheck stub prevails. Your company has selected Guardian to provide Life coverage to eligible employees according to plan terms, which have been mutually agreed upon. As an eligible employee, you can purchase this coverage at the group premium levels.

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Critical Illness Benefit Summary

Effective: March 01, 2014

Group Number: 482733

About Your Benefits:

Critical illness insurance covers what medical and disability insurance doesn’t pay for - uncovered medical expenses and non-medical

expenses associated with critical illnesses. Since 9 out of 10 consumers know someone or have a family member who has suffered a

critical illness

1

_{, and two-thirds of the costs of cancer are non-medical}

2

_{, it’s clear that critical illnesses are common, costly, and will}

eventually affect virtually every family. When it does, if you don’t have critical illness coverage, you won’t be covered for certain

medical treatments and deductibles, and you won’t get extra money to cover household bills. So, make your selections and enroll in

Guardian Critical Illness today!

1_{Guardian Omnibus Study, 2008.}2_{American Cancer Society, 2007}

What Your Benefits Cover:

Heidelberg University

Heidelberg University All employees Benefit Summary

The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

CRITICAL ILLNESS

Benefit Amount(s) Employee may choose a lump sum benefit of $5,000 to $25,000 in $5,000 increments.

CONDITIONS PERCENTAGE OF LUMP SUM

1st OCCURRENCE 2nd OCCURRENCE

Cancer Type 1 (Invasive) 100% 50%

Heart Attack 100% 50%

Kidney Failure 100% 50%

Organ Transplant 0% 0%

Stroke 100% 50%

Cancer Type 2 (Non-Invasive) 25% 0%

Coronary Artery Bypass Graft 0% 0%

Spouse Benefit 50% of employee's lump sum benefit

Child Benefit- children age 14 days to 23 years (25 if full time

student) 50% of employee's lump sum benefit

Benefit Reductions: Benefits are reduced by a certain percentage as

an employee ages 35% at age 65, 60% at age 70, 75% at age 75, 85% at age 80 Guarantee Issue/

Conditional Issue For a spouse:

15-39 $2,500 40-54 $2,500 55-69 $2,500 For a child: $2,500

and spouses to elect up to $12,500 and Child to elect up to $12,500. Dependent Guarantee & Conditional Issue amounts are limited to 50% of the amount purchased by the employee.

Portability: Allows you to take your Critical Illness coverage with you if you terminate employment.

An insured may port Critical Illness coverage only after being insured by this plan for "a state specific amount of time." An insured's ported certificate ends at age 70.

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Heidelberg University All employees Benefit Summary

The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

CRITICAL ILLNESS

Pre-Existing Condition Limitation: A pre-existing condition includes any condition for which you, in the specified time period prior to coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs.

6 months prior, 24 months after

Total Amount Payable During your lifetime, this plan will not pay more than 150% of the lump sum benefit for all critical illnesses combined.

Benefit Waiting Period: We do not pay benefits for a critical illness that occurs during the benefit waiting period.

Cancer: 30 Days Non-Cancer: 30 Days

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Critical Illness Cost Illustration

To determine the most appropriate level of coverage, you should consider your current basic monthly expenses and

expected financial needs during a critical illness.

Heidelberg University All employees Benefit Summary

The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

Your premium will not increase as you age.

Semi-monthly Premiums Displayed

Election Cost Per Age Bracket

Issue Age <20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-99† $5,000 Benefit Amount Employee $5,000 Spouse $2,500 Child $2,500 $1.40 $0.70 $0.22 $1.60 $0.80 $0.22 $1.88 $0.94 $0.22 $2.35 $1.18 $0.22 $3.15 $1.58 $0.22 $4.58 $2.29 $0.22 $6.80 $3.40 $0.22 $9.75 $4.88 $0.22 $13.40 $6.70 $0.22 $18.70 $9.35 $0.22 $27.38 $13.69 $0.22 $10,000 Benefit Amount Employee $10,000 Spouse $5,000 Child $5,000 $2.80 $1.40 $0.43 $3.20 $1.60 $0.43 $3.75 $1.88 $0.43 $4.70 $2.35 $0.43 $6.30 $3.15 $0.43 $9.15 $4.58 $0.43 $13.60 $6.80 $0.43 $19.50 $9.75 $0.43 $26.80 $13.40 $0.43 $37.40 $18.70 $0.43 $54.75 $27.38 $0.43 $15,000 Benefit Amount Employee $15,000 Spouse $7,500 Child $7,500 $4.20 $2.10 $0.64 $4.80 $2.40 $0.64 $5.63 $2.82 $0.64 $7.05 $3.53 $0.64 $9.45 $4.73 $0.64 $13.73 $6.87 $0.64 $20.40 $10.20 $0.64 $29.25 $14.63 $0.64 $40.20 $20.10 $0.64 $56.10 $28.05 $0.64 $82.13 $41.07 $0.64 $20,000 Benefit Amount Employee $20,000 Spouse $10,000 Child $10,000 $5.60 $2.80 $0.85 $6.40 $3.20 $0.85 $7.50 $3.75 $0.85 $9.40 $4.70 $0.85 $12.60 $6.30 $0.85 $18.30 $9.15 $0.85 $27.20 $13.60 $0.85 $39.00 $19.50 $0.85 $53.60 $26.80 $0.85 $74.80 $37.40 $0.85 $109.50 $54.75 $0.85 $25,000 Benefit Amount Employee $25,000 Spouse $12,500 Child $12,500 $7.00 $3.50 $1.07 $8.00 $4.00 $1.07 $9.38 $4.69 $1.07 $11.75 $5.88 $1.07 $15.75 $7.88 $1.07 $22.88 $11.44 $1.07 $34.00 $17.00 $1.07 $48.75 $24.38 $1.07 $67.00 $33.50 $1.07 $93.50 $46.75 $1.07 $136.88 $68.44 $1.07

†_{Benefit reductions may apply. See plan details.}

Manage Your Benefits:

Enrolled members and their dependents can access

helpful, secure information about their Guardian benefits at

www.guardiananytime.com

Questions?

Call the Guardian Helpline (888) 600-1600

Call weekdays, 7:00 AM to 8:30 PM, EST. And refer

to your plan number : 482733

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Heidelberg University All employees Benefit Summary

The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

EXCLUSIONS AND LIMITATIONS

A SUMMARY OF PLAN LIMITATIONS AND EXCLUSIONS FOR CRITICAL ILLNESS:

We do not pay benefits for a first ever occurrence of a Critical Illness that occurs less than 12 months after the first ever occurrence of a different Critical Illness for which this plan paid benefits. If the insured has exhibited symptoms or received treatment within the past 24 months for a Critical Illness, we do not pay benefits for the second ever occurrence of that Critical Illness. We do not pay benefits for a third or later occurrence of a Critical Illness.

We do not pay benefits for claims relating to a covered person: taking part in any war or act of war (including service in the armed forces) committing a felony or taking part in any riot or other civil disorder or intentionally injuring themselves or attempting suicide while sane or insane.

Employees must be legally working in the United States in order to be eligible for coverage. Underwriting must approve coverage for employees on temporary assignment: (a) exceeding 1 year; or (b) in an area under travel warning by the US Department of State, subject to state specific variations.

If the plan is new (not transferred): During the exclusion period, this Critical Illness plan does not pay charges relating to a pre-existing condition. If this plan is transferred from another insurance carrier, the time an insured is covered under that plan will count toward satisfying Guardian’s pre-existing condition

limitation period. A pre-existing condition includes pregnancy and any condition for which an employee, in a specified time period prior to coverage in this plan, consults with a physician, receives treatment, or takes prescribed drugs. Please refer to the plan documents for specific time periods. State variations may apply.

Guardian's Critical Illness plan does not provide comprehensive medical coverage. It is a basic or limited benefit and is not intended to cover all medical expenses. It does not provide "basic hospital," "basic medical," or "medical" insurance as defined by the New York State Insurance Department.

Evidence of Insurability is required on all late enrollees and enrollees over age 69 (not applicable in FL). This coverage will not be effective until approved by a Guardian underwriter.

The policy has exclusions and limitations that may impact the eligibility for or entitlement to benefits under each covered condition. See your certificate booklet for a full listing of exclusions & limitations.

If Critical Illness insurance premium is paid for on a pre tax basis, the benefit may be taxable. Please contact your tax or legal advisor regarding the tax treatment of your policy benefits.

This handout is for illustrative purposes only and is an approximation. If any discrepancies between this handout and your paycheck stub exist, your paycheck stub prevails. Your company has selected Guardian to provide Critical Illness coverage to eligible employees & dependents according to plan terms which have been mutually agreed upon. As an eligible employee, you can purchase this coverage at the group premium levels illustrated above.

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How to ensure that an emotionally difficult time is

not also a financially stressful time

The fact is medical problems contributed to over 60% of all bankruptcies in the U.S. in 2007,

even though more than 77% were insured at the start of their bankrupting illness.* When

someone is fighting or recovering from a critical illness such as cancer, heart attack or stroke,

they face a number of medical and non-medical expenses that are not covered by traditional

insurance. It’s hard to anticipate these types of expenses until an illness occurs. Critical Illness

coverage helps to ease the burden of those non-covered expenses.

Critical Illness coverage provides a lump sum benefit payment to a person diagnosed with a

serious illness. The lump sum payment can be used any way you choose. This financial

support supplements medical, disability and life insurance by helping to pay for unforeseen

expenses when a serious illness occurs.

Critical Illness coverage complements other insurance.

Medical Insurance

Fundamental Protection for Medical

Expenses: Coverage for medical

expenses – but not deductibles or

out-of-pocket expenses.

Disability Insurance

Essential in any Financial Plan:

Protection for personal income –

but what if expenses outweigh that

income?

Life Insurance

Fundamental Protection for

Tomorrow: Financial support for

loved ones in the future – but how

do you manage today?

Critical Illness Insurance

Coverage to Fill the Gap: Coverage

for the uninsured expenses that

mount up through treatment and

recovery.

* Medical Bankruptcy in the United States, 2007. Results of a National Study published by the American Journal of Medicine, August 2009, Vol. 122, Issue 8. Authors David U. Himmelstein, MD, Deborah Thome, PhD, Elizabeth Warren, JD, and Steffie Woolhandler, MD, MPH

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Q: What type of illness does a person need to be

diagnosed with to get a payment?

A: Guardian Critical Illness plans provide coverage when a

person is diagnosed or experiences (for the first or second

time) the following prevalent health events:

• Cancer

• Heart attack

• Stroke

• Major organ transplant

• Kidney Failure (end stage renal failure)

• Coronary Artery Bypass Graft (CABG)

If a Hospital Admission Benefit is part of your Guardian Critical

Illness plan, you also receive coverage for conditions other

than those listed above. Guardian will provide a benefit

payment for each day you are in the hospital for any illness

other than these covered critical illnesses, for up to 10 days per

plan year.

Q: Who needs this type of coverage?

A: Everyone. Due to rising diagnoses of serious illnesses in

America, the need for Critical Illness coverage is more

important than ever. Many people when faced with the

unexpected expenses of a major illness are forced to tap into

their savings or retirement accounts, take out a second

mortgage or run up high interest credit cards. Guardian Critical

Illness coverage helps protect your financial health as you

recover. It’s an affordable way to make sure an emotionally

difficult time is not financially stressful too.

Q: What’s the best way to purchase it?

A: Your workplace makes it easy for you to enroll in Critical

Illness insurance coverage. Your employer has reviewed

various plans to provide you with a quality plan, at affordable

rates. Plus, you have the convenience of payroll deduction so

you won’t have to worry about making payments.

Many expenses are not covered by

any other insurance.

• Out-of network medical costs

• Deductibles

• Potential loss of spouse’s income for

time off

• Co-payments for new prescriptions

• Ongoing bills like mortgages and loans

• Travel to and from treatment facilities

• Experimental treatments

• Child care

• Elder care

• Home care nurse

• Home modifications (such as ramps) to

accommodate disability

• Overnight accommodations/food/etc.

while away from home to receive

treatment/care

Guardian’s Critical Illness plan does not provide

comprehensive medical coverage. It is a basic or limited

benefit and is not intended to cover all medical expenses. It

does not provide “basic hospital”, “basic medical”, or

“medical” insurance as defined by the New York State

Insurance Department. Product may not be available in all

states. For full plan features, including exclusions and

limitations, please refer to the policy contract.

GP-1-CIP-IC-07.

The Guardian Life Insurance Company of America, New

York, NY 10004 2011-3365

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Guardian has made your Critical Illness plan even

better!

The following provisions have been enhanced from what is shown in your enrollment kit:

Total Amount Payable

• Guardian will not pay more than 300% of your lump sum benefit during your lifetime. This was increased

from 150% which is shown in the Plan Details of your enrollment kit.

Exclusions and Limitations

• We do not pay benefits for a first ever occurrence of a critical illness that occurs less than 3 months after

the first ever occurrence of a different critical illness. This time frame is reduced from 12 months shown

in the exclusions section of your enrollment kit.

• If the insured has exhibited symptoms or received treatment (not including routine follow up visits or

preventative medications) within the past 12 months for a critical illness, we do not pay benefits for a

second ever occurrence of that illness. This time frame is reduced from 24 months shown in the

exclusions section of your enrollment kit.

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Accident Benefit Summary

About Your Benefits:

Guardian Accident Insurance empowers you to protect yourself financially. Some things in life are out of your control - having an

accident is one of them. Ensuring you have the right coverage can give you financial confidence, regardless of whether you play it

safe or like to take chances. Guardian Accident Insurance ensures you are covered for specific services and care associated with an

injury. The plan provides you with the financial resources to make getting back to your regular routine as easy as possible.

Effective: March 01, 2014

Group Number: 482733

Heidelberg University All employees Benefit Summary

The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

Heidelberg University

What Your Benefits Cover:

ACCIDENT COVERAGE - DETAILS

Your Semi-monthly premium $8.27

You and Spouse $12.77

You and Child(ren) $13.05

You, Spouse and Child(ren) $17.54

Accident Coverage Type On and Off Job

Portability - Allows you to take your Accident coverage with you if you terminate employment. Ported Accident plan terminates at age 70.

Included

ACCIDENTAL DEATH AND DISMEMBERMENT

Benefit Amount(s)

Employee $10,000 Spouse $5,000 Child $5,000

Catastrophic Loss

Quadriplegia, Loss of speech & hearing (both ears), Loss of Cognitive function: 100% of AD&D Hemiplegia & Paraplegia: 50% of AD&D

Common Carrier 200% of AD&D benefit

Common Disaster 200% of Spouse AD&D benefit

Dismemberment - Hand, Foot, Sight Single: 50% of AD&D benefit Multiple: 100% of AD&D benefit Dismemberment - Thumb/Index Finger Same Hand, Four Fingers Same Hand, All

Toes Same Foot

25% of AD&D benefit

Seatbelts and Airbags Seatbelts: $10,000 & Airbags: $15,000 Reasonable Accommodation to Home or Vehicle $2,500

Child(ren) Age Limits Children age birth to 26 years (26 if full time student) FEATURES

Accident Emergency Room Treatment $150

Accident Follow-Up Visit - Doctor $25 up to 6 treatments

Air Ambulance $500

Ambulance $100

Appliance - Wheelchair, leg or back brace, crutches, walker, walking boot that extends above the ankle or brace for the neck.

$100

Blood/Plasma/Platelets $300

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Heidelberg University All employees Benefit Summary

The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

FEATURES (Cont.)

Burns (2nd Degree/3rd Degree)

9 sq inches to 18 sq inches: $0/$2,000 18 sq inches to 35 sq inches: $1,000/$4,000 Over 35 sq inches: $3,000/$12,000

Burn - Skin Graft 50% of burn benefit

Child Organized Sport - Benefit is paid if the covered accident occurred while your covered child is participating in an organized sport that is governed by an

organization and requires formal registration to participate.

20% increase to child benefits

Coma $7,500

Concussions $50

Dislocations Schedule up to $3,600

Diagnostic Exam (Major) $100

Emergency Dental Work $200/Crown, $50/Extraction

Epidural pain management $100, 2 times per accident

Eye Injury $200

Family Care $20/day up to 30 days

Fracture Schedule up to $4,500

Hospital Admission $750

Hospital Confinement $175/day - up to 1 year

Hospital ICU Admission $1,500

Hospital ICU Confinement $350/day - up to 15 days Initial Physician's office/Urgent Care Facility Treatment $50

Joint Replacement (hip/knee/shoulder) $1,500/$750/$750

Knee Cartilage $500

Laceration Schedule up to $300

Lodging - The hospital must be more than 50 miles from the insured's residence. $100/day, up to 30 days for companion hotel stay Occupational or Physical Therapy $25/day up to 10 days

Prosthetic Device/Artificial Limb 1: $500

2 or more: $1,000 Rehabilitation Unit Confinement $150/day up to 15 days Ruptured Disc With Surgical Repair $500

Surgery Schedule up to $1,000

Hernia: $125 Surgery - Exploratory or Arthroscopic $150

Tendon/Ligament/Rotator Cuff 1: $250

2 or more: $500 Transportation - Benefit is paid if you have to travel more than 50 miles one way to

receive special treatment at a hospital or facility due to a covered accident.

$400, 3 times per accident

X - Ray $20

UNDERSTANDING YOUR BENEFITS:

• Common Carrier – Benefit is paid if an insured's death occurs due to an accident while riding as a fare-paying passanger in a

public conveyance. If this is paid, we do not pay the Accidental Death benefit.

• Common Disaster – Benefit is paid if both you & your spouse die in a covered accident or separate covered accidents

within the same 24 hour period.

• Reasonable Accomodation – Benefit is payable if a modification is required to an insured's place of residence or vehicle due

to an Accidental Dismemberment or Catastrophic loss.

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Heidelberg University All employees Benefit Summary

The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

Manage Your Benefits:

Enrolled members and their dependents can access

helpful, secure information about their Guardian benefits at

www.guardiananytime.com

Questions?

Call the Guardian Helpline (888) 600-1600

Call weekdays, 7:00 AM to 8:30 PM, EST. And refer

to your plan number : 482733

LIMITATIONS AND EXCLUSIONS:

A SUMMARY OF ACCIDENT LIMITATIONS AND EXCLUSIONS:

Employees must be working in the United States in order to be eligible for coverage. Underwriting must approve coverage for employees on temporary assignment: (a) exceeding 1 year; or (b) in an area under travel warning by the US Department of State, subject to state specific variations.

This proposal summarizes the major features of the Guardian Accident benefit plan. It is not intended to be a complete representation of the proposed plan. For full plan features, including exclusions and limitations, please refer to your Policy.

This proposal is hedged subject to satisfactory financial evaluation.

This plan will not pay benefits for any injury caused by or related to: declared or undeclared war, act of war or armed aggression; taking part in a riot or civil disorder; or commission of, or attempt to commit a felony; intentionally self

inflicted injury, while sane or insane; suicide, while sane or insane. The covered person being legally intoxicated. Treatment rendered or hospital confinement outside the United States or Canada. Travel of flight in any kind of aircraft including any aircraft owned by or for the employer except as a fare paying passenger on a common carrier. Participation in any kind of sporting activity for compensation or profit including coaching or officiating.

Riding in or driving any motor-driven vehicle in a race, stunt show or speed test. Participation in hang gliding, bungee jumping, sailgliding, parasailing, parakiting, ballooning, parachuting, and/or skydiving. Injuries to a dependent child received during the birth. An accident that occurred before the covered person is covered by this plan. Sickness, disease, mental infirmity or medical or surgical treatment.

If Accident insurance premium is paid for on a pre tax basis, the benefit may be taxable. Please contact your tax or legal advisor regarding the tax treatment of your policy benefits.

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ADDITIONAL MATERIALS

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Employee Benefits Hotline (EBH)

Benefit specialists are available to answer questions as you sign up for

your Guardian benefits

Toll-free Phone

1-888-600-1600

Monday-Friday

7:00 a.m. – 8:30 p.m. EST

6:00 a.m. – 7:30 p.m. CST

5:00 a.m. – 6:30 p.m. MST

4:00 a.m. – 5:30 p.m. PST

STEP 1: Ask yourself these questions to determine if you should call

the Employee Benefits Hotline.

If you answer “yes” to any of these questions, prepare to contact the Hotline (go to STEP 2):

• Do I need help completing my enrollment forms?

• Do I have questions about the benefits covered under the plans my employer is offering?

STEP 2: Prepare to contact the Hotline

• Name of the company you work for

• Your company’s group number

STEP 3: Call 888-600-1600 to get answers!

• Press #1 to identify yourself as an employee.

• At the next prompt: Press #0 for all other questions

• Enter your company’s group number

IMPORTANT NOTE: The Employee Benefits Hotline provides pre-enrollment support in over 50 languages!

Once you are enrolled in a plan, you will receive additional information and new toll-free phone numbers.

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1

Questions? Call the Guardian Helpline (888) 600-1600 www.guardianlife.com

DETACH ENTIRE FORM AND RETURN TO YOUR EMPLOYER

DATE FORM PUBLISHED: Jan 24, 2014

The Guardian Life Insurance Company of America

Enrollment/Change Form

Page 1 of 4

Midwest Regional Office, P.O. Box 8012, Appleton, WI 54912-8012

Plan Administrator: Margaret Rudolph Please print clearly and mark carefully.

CEF2012-OH

Employer Name:

Heidelberg University

Group Plan Number:

482733

Benefits Effective:_____________ PLEASE CHECK APPROPRIATE BOX qInitial Enrollment qRe-Enrollment qAdd Employee/Dependents qDrop/Refuse Coverage qInformation Change

qIncrease Amount qFamily Status Change

Class: All employees Division:_________________ Subtotal Code:____________________ (Please obtain this from your Employer)

About You:

Social Security Number

First, MI, Last Name:

___ ___ ___ - ___ ___ - ___ ___ ___ ___

Address City State Zip

Gender:qM qF Date of Birth_{(mm-dd-yy): ____ - ____ - ____} Phone:₍ ₎

-Email Address: Are you married or do you have a spouse?qYes qNo Date of marriage/union:____-____-_____ Do you have children or other dependents?qYes qNo Placement date of adopted child:____-____-_____

About Your Job:

Hours worked per week:_______ Job Title:

Work Status:

qActive qRetired qCobra/State Continuation Date of full time hire:____ - ____ - ____ Annual Salary: $____________

About Your Family: Please include the names of the dependents you wish to enroll for coverage. A dependent is a person that you,

as a taxpayer, claim; who relies on you for financial support; and for whom you qualify for a dependency tax exception.

Dependency tax exemptions are subject to IRS rules and regulations. Additional information may be required for non-standard

dependents such as a grandchild, a niece or a nephew.

Spouse (First, MI, Last Name) Gender qMqF

Date of Birth (mm-dd-yyyy) ____ - ____ - ____ Child/Dependent 1: _q_Add_q_{Drop Gender}

qMqF

Date of Birth (mm-dd-yyyy) ____ - ____ - ____

Status (check all that apply)

qStudent (post high school)qDisabled qNon standard dependent

State of Residence:_{____________________} Child/Dependent 2: _q_Add_q_{Drop Gender}

qMqF

State of Residence:_{____________________} Child/Dependent 3: _q_Add_q_{Drop Gender}

qMqF

State of Residence:____________________ Child/Dependent 4: _q_Add_q_{Drop Gender}

qMqF

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2 DETACH ENTIRE FORM AND RETURN TO YOUR EMPLOYER

Drop Coverage:

qDrop Employee qDrop Dependents

The date of withdrawal cannot be prior to the date this form is completed and signed.

Last Day of Coverage:_____-_____-_____ qTermination of Employment qRetirement

Last Day Worked:_____-_____-_____ qOther Event:_____________

Date of Event:_____-_____-_____

Coverage Being Dropped:

qCritical Illness qEmployee qSpouse qChild(ren) qAccident qEmployee qSpouse qChild(ren) qShort Term Disability

I have been offered the above coverage(s) and wish to drop enrollment for the following reasons: qCovered under another insurance plan

qOther____________________________________________________ (additional information may be required)

Short-Term Disability (STD) Coverage:

Weekly Benefit Weekly Benefit

q$200.00 q$250.00 q$300.00 q$350.00 q$400.00 q$450.00 q$500.00 q$550.00 q$600.00 q$650.00

This amount may not exceed 60% of your weekly salary. q$700.00 q$750.00 q$800.00 q$850.00 q$900.00 q$950.00 q$1,000.00 q$1,100.00 q$1,200.00 q$1,300.00 qI do not want this coverage.

Critical Illness Coverage:

You must be enrolled to cover your dependents Employee

Insurance Amount: _q_$5,000 _q_$10,000 _q_$15,000 _q_$20,000 _q_$25,000

qI do not want this coverage.

Spouse

Insurance Amount: q50% of the employee's amount q I do not want this coverage.

Dependent/Child(ren)

Insurance Amount: q50% of the employee's amount q I do not want this coverage.

If you or your dependent spouse or dependents elect Critical illness Coverage, you must answer the following health questions.

Has any proposed insured been diagnosed with or treated for any of the following conditions: cancer, carcinoma in situ, malignant melanoma, any chronic or progressive disease of heart, kidneys, liver, lungs, pancreas or bone marrow? Or, been advised to have an organ transplant, including bone marrow or stem cell transplant? EmployeeqYesqNo SpouseqYesqNo Dependent Child (ren) qYesqNo

Has the proposed insured been diagnosed with or treated for: heart attack or heart disease, stroke or transient ischemic attack (TIA), or have you had or been advised to have bypass surgery, stent insertions, treatment to coronary arteries?

EmployeeqYesqNo SpouseqYesqNo Dependent Child (ren) qYesqNo

Has the proposed insured been diagnosed with or treated for uncontrolled blood pressure (requiring a change in medication or dosage in the past 6 months) or been diagnosed with or treated for diabetes (except if present only in pregnancy)?

EmployeeqYesqNo SpouseqYesqNo Dependent Child (ren) qYesqNo

IMPORTANT NOTES:

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3

Guardian Group Plan Number:

482733

Please print employee name:

DETACH ENTIRE FORM AND RETURN TO YOUR EMPLOYER

Questions? Call the Guardian Helpline (888) 600-1600 www.guardianlife.com

Accident Coverage

You must be enrolled to cover your dependents. Check only one box.

Your Semi-monthly premium Employee Only EE & Spouse EE &

Dependent/Child(ren)

EE, Spouse & Dependent/Child(ren) q$8.27 q$12.77 q$13.05 q$17.54

qI do not want this coverage.

Name your beneficiaries: (Primary beneficiary percentages must total 100%) Primary Beneficiaries: Name: _% _ Relationship to Employee: _ Name: _% _ Relationship to Employee: _ Contingent Beneficiary: __ Relationship to Employee: _

(In the event the designated beneficiaries are deceased, the contingent beneficiary will receive the benefit. Employer maintains beneficiary information.)

Signature

l I understand that the premium amounts shown above are estimations and are for illustrative purposes only.

l Submission of this form does not guarantee coverage. Among other things, coverage is contingent upon underwriting approval and meeting the applicable eligibility requirements as set forth in the applicable benefit booklet.

l You must be legally working in the United States in order to be eligible for coverage. Underwriting must approve coverage for employees on temporary assignment (a) exceeding 1 year; or (b) in an area under travel warning by the US Department of State, subject to state specific variations. You must be legally working in the United States, or working outside of the United States for a United States based employer in a country or region approved by us.

l If coverage is waived and you later decide to enroll, late entrant penalties may apply. You may also have to provide, at your own expense, proof of each person's insurability. Guardian has the right to reject your request.

l I understand that I must be actively at work or my elected coverage will not take effect until I have met the eligibility requirements (as defined in the benefit booklet.) This does not apply to eligible retirees.

l Plan design limitations and exclusions may apply. For complete details of coverage, please refer to your benefit booklet. State limitations may apply.

l Your coverage will not be effective until approved by a Guardian or its designated underwriter.

l I hereby apply for the group benefit(s) that I have chosen above.

l I understand that I must meet eligibility requirements for all coverages that I have chosen above.

l I agree that my employer may deduct premiums from my pay if they are required for the coverage I have chosen above.

l I acknowledge and consent to receiving electronic copies of applicable insurance related documents, in lieu of paper copies, to the extent permitted by applicable law. I may change this election only by providing Guardian thirty (30) day prior written notice.

l I attest that the information provided above is true and correct to the best of my knowledge.

Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

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4

The state in which you reside may have a specific state fraud warning. Please refer to the attached Fraud Warning Statements page.

The laws of New York require the following statement appear: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. (Does not apply to Life Insurance.)

SIGNATURE OF EMPLOYEE X___________________________________________ DATE______________________

Enrollment Kit 482733, 0003, EN

Fraud Warning Statements

The laws of several states require the following statements to appear on the enrollment form:

Alabama: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for

insurance is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof.

Arizona: For your protection Arizona law requires the following statement to appear on this form. Any person who knowingly presents a false or fraudulent claim for payment

of a loss is guilty of a crime and may be subject to criminal and civil penalties.

California: For your protection California law requires the following to appear on this form: Any person who knowingly presents false or fraudulent claim for the payment of a

loss is guilty of a crime and may be subject to fines and confinement in state prison.

Colorado: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to

defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policy holder or claimant for the purpose of defrauding or attempting to defraud the policy holder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.

Connecticut, Iowa, Kansas, Nebraska, Oregon, and Vermont: Any person who knowingly, and with intent to defraud any insurance company or other person, files an

application of insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, may be guilty of a fraudulent insurance act, which may be a crime, and may also be subject to civil penalties.

Delaware, Indiana and Oklahoma: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an

insurance policy containing any false, incomplete or misleading information is guilty of a felony.

District of Columbia: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties

include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant.

Florida: Any person knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or application containing any false, incomplete, or

misleading information is guilty of a felony of the third degree.

Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information

or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.

Louisiana and Texas: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit is guilty of a crime and may be subject to fines and

confinement in state prison.

Maine, Tennessee, Virginia and Washington: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of

defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.

Maryland : Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or knowingly or willfully presents false information in an

application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Rhode Island: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or knowingly and willfully presents false

information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Minnesota: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime.

New Hampshire: Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim containing any false, incomplete or

misleading information is subject to prosecution and punishment for insurance fraud, as provided in N.H. Rev. Stat. Ann. § 638:20

New Jersey: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties.

New Mexico: Any person who knowingly presents a false or fraudulent claim for payment or a loss or benefit or knowingly presents false information in an application for

insurance is guilty of a crime and may be subject to civil fines and criminal penalties or denial of insurance benefits.

Pennsylvania: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim

containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.