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Brooks RehabilitationAccident InsurancePlan SummaryACCIDENT INSURANCE BENEFITSWith MetLife, you’ll be offered a comprehensive plan which provide payments in addition to any other insurance payments you mayreceive1. Here are just some of the covered events/services2.BENEFIT AMOUNTSBENEFITBENEFIT LIMITSEMPLOYEESPOUSECHILD 20,000 20,000 20,000 40,000 40,000 40,000PARALYSIS BENEFIT CATEGORYTwo Limbs (paraplegia or hemiplegia)N/AFour Limbs (quadriplegia)BENEFITBENEFIT LIMITSBENEFITAMOUNTSALL COVEREDPERSONSACCIDENTAL INJURY BENEFITS CATEGORYFracture Benefit (Closed)Face or Nose (except mandible or maxilla) 2,000Skull Fracture - depressed (except bones of face or nose) 9,625Skull Fracture - non-depressed (except bones of face or nose) 5,000Lower Jaw, Mandible (except alveolar process) 1,400Upper Jaw, Maxilla (except alveolar process) 2,000Upper Arm between Elbow and Shoulder (humerus) 2,000Shoulder Blade (scapula), Collarbone (clavicle, sternum) 1,400Forearm (radius and/or ulna), Hand, Wrist (except fingers)RibFinger, ToeIf more than one bone is fractured, theamount we will pay for all fracturescombined will be no more than 2 timesthe highest Fracture Benefit. 1,050 1,000 525Vertebrae, Body of (excluding vertebral processes) 2,625Vertebral Process 1,400Pelvis (includes ilium, ischium, pubis, acetabulum except coccyx) 2,625Hip, Thigh (femur) 5,000Coccyx 750Leg (tibia and/or fibula) 2,625Kneecap (patella) 1,050Ankle 1,050ADF# AI664.14

Foot (except toes) 1,050Chip Fracture25%Fracture Benefit (Open)Face or Nose (except mandible or maxilla) 4,000Skull Fracture - depressed (except bones of face or nose) 14,438Skull Fracture - non depressed (except bones of face or nose) 10,000Lower Jaw, Mandible (except alveolar process) 2,100Upper Jaw, Maxilla (except alveolar process) 4,000Upper Arm between Elbow and Shoulder (humerus) 4,000Shoulder Blade (scapula), Collarbone (clavicle, sternum) 2,100Forearm (radius and/or ulna), Hand, Wrist (except fingers) 2,000If more than one bone is fractured, theamount we will pay for all fracturescombined will be no more than 2 timesthe highest Fracture Benefit.RibFinger, Toe 2,000 788Vertebrae, Body of (excluding vertebral processes) 4,000Vertebral Process 2,100Pelvis (includes ilium, ischium, pubis, acetabulum except coccyx) 4,000Hip, Thigh (femur) 10,000Coccyx 1,500Leg (tibia and/or fibula) 4,000Kneecap (patella) 1,575Ankle 1,575Foot (except toes) 1,575Chip Fracture25%Dislocation Benefit (Closed)Lower Jaw 1,600Collarbone (sternoclavicular) 1,600Collarbone (acromioclavicular and separation) 1,000Shoulder (glenohumeral) 1,600Rib 1,600ElbowWristBone or Bones of the Hand (other than fingers)If more than one joint is dislocated, theamount we will pay for all dislocationscombined will be no more than 2 timesthe highest Dislocation Benefit. 1,600 1,600 1,600Hip 8,000Knee (except patella) 4,000Ankle - Bone or bones of the Foot (other than toes) 2,000One Toe or Finger 400Partial Dislocation25%Dislocation Benefit (Open)Lower JawIf more than one joint is dislocated, the 2,400

amount we will pay for all dislocationscombined will be no more than 2 timesthe highest Dislocation Benefit.Collarbone (sternoclavicular)Collarbone (acromioclavicular and separation) 3,000 2,000Shoulder (glenohumeral) 2,400Rib 2,400Elbow 2,400Wrist 2,400Bone or Bones of the Hand (other than fingers) 2,400Hip 12,000Knee (except patella) 6,000Ankle - Bone or bones of the Foot (other than toes) 3,000One Toe or Finger 600Partial Dislocation25%Burn Benefit2nd Degree w/ less than 10% of surface skin burnt 1,0002nd Degree 10-25% surface skin burnt 1,5002nd Degree 25-35% surface skin burnt 1,5002nd Degree 35% or more of surface skin burnt1 time per accident;Unlimited time(s) per year3rd Degree w/ less than 10% of surface skin burnt 1,500 10,0003rd Degree 10-25% surface skin burnt 15,0003rd Degree 25-35% surface skin burnt 25,0003rd Degree 35% or more of surface skin burnt 27,000Concussion BenefitConcussion1 time(s) per year 5001 time(s) per accident;Unlimited time(s) per year 20,000Coma BenefitComaLaceration BenefitWithout repair by stiches 75Repaired by stiches but less than 2 inches long1 time per accident;3 time(s) per yearRepaired by stiches and 2-6 inches longRepaired by stiches and over 6 inches long 75 350 700Broken Tooth BenefitCrown1 time(s) per accident;3 time(s) per year (applies to allprocedures) 300Extraction1 time(s) per accident;3 time(s) per year (applies to allprocedures) 150Filling1 time(s) per accident;3 time(s) per year (applies to allprocedures) 501 time(s) per accident; 400Eye Injury BenefitEye Injury

2 time(s) per yearBENEFITBENEFIT LIMITSBENEFITAMOUNTSALL COVEREDPERSONSMEDICAL TREATMENT AND SERVICES BENEFITS CATEGORYGround Ambulance BenefitGround Ambulance1 time(s) per accident;2 time(s) per year 4001 time(s) per accident;2 time(s) per year 1,500Air Ambulance BenefitAir AmbulanceEmergency Care BenefitEmergency Room 2001 time per accident (combined with NonEmergency Initial Care Benefit)Physician’s OfficeUrgent Care 200 200Non-Emergency Initial Care Benefit1 time per accident (combined withEmergency Care Benefit)Non-Emergency Initial Care 100Medical Testing BenefitMedical Testing (X-rays, MRI/MR, Ultrasound, NCV, CT/CAT, EEG)1 time(s) per accident;2 time(s) per year 2004 time(s) per accident;12 time(s) per year 1001 time(s) per accident;2 time(s) per year 400Physician Follow-Up BenefitPhysician Follow-Up VisitTransportation BenefitTransportationTherapy Services BenefitCognitive Behavioral Therapy 60Occupational Therapy 60Physical Therapy10 time(s) per accident;15 time(s) per yearRespiratory therapy 60 60Speech Therapy 60Vocational Therapy 60Pain Benefit1 time(s) per accident;Unlimited time(s) per yearPain Management (for Epidural Anesthesia) 150Prosthetic Device BenefitOne Device Only1 time(s) per accident;Unlimited time(s) per yearMore than One Device 1,500 3,000Medical Appliance BenefitBrace 150

Cane 150Crutches 150Walker - expected use 1yr 200Walker - expected use 1 yr 400Walking Boot 150Wheel chair or motorized scooter - expected use 1yr 300Wheel chair or motorized scooter - expected use 1yr 1,000Other medical device used for Mobility 150Medical Appliance Benefit Limit (for all appliances combined peraccident) 1,000Modification Benefit1 time(s) per accident;Unlimited time(s) per yearModification 1,500Blood/ Plasma/ Platelets Benefit1 time(s) per accident;Unlimited time(s) per yearBlood/Plasma/Platelets 500Surgery BenefitsSurgical Repair – Cranial 2,000Surgical Repair – Hernia 200Surgical Repair – Ruptured Disc 1,500Surgical Repair – Skin Graft Benefit50%Surgical Repair – Torn Cartilage in Knee 1,5001 time(s) per accident;2 time(s) per yearSurgical Repair – Torn tendon/ligament/rotator cuff - one 1,000Surgical Repair – Torn tendon/ligament/rotator cuff - two or more 2,000Surgical Repair – Thoracic Cavity or Abdominal Pelvic Cavity 2,000Exploratory Surgery (for any Surgery Benefit procedure) 200Other Outpatient Surgery Benefit1 time(s) per accident;2 time(s) per yearOther Outpatient Surgery BenefitBENEFITBENEFIT LIMITS 400BENEFITAMOUNTSALL COVEREDPERSONSACCIDENT – HOSPITAL BENEFITS CATEGORYHospital Admission BenefitAdmission1 time per accident;Unlimited times per year 2,000Hospital Confinement BenefitConfinement15 days per accident. Payable after the 400

ICU Supplemental Confinement (paid in addition to Confinement)first day of admission.ICU Supplemental Confinement will payan additional benefit for 15 of those days. 400Inpatient Rehabilitation Benefit30 days per accident;30 days per yearInpatient RehabilitationBENEFITBENEFIT LIMITS 200BENEFITAMOUNTSALL COVEREDPERSONSOTHER BENEFITS CATEGORYLodging Benefit30 day(s) per year 200Notes Regarding Certain Benefits: Lodging Benefit: The lodging benefit is not available in all states. It provides a benefit for a companion accompanying a coveredinsured while hospitalized, provided that lodging is at least 50 miles from the insured’s primary residence.Please contact MetLife for detailed definitions and state variations of covered benefits.

BENEFIT PAYMENT EXAMPLEKathy’s daughter, Molly, plays soccer on the varsity high schoolteam. During a recent game, she collided with an opposing player,was knocked unconscious and taken to the local emergency roomby ambulance for treatment. The ER doctor diagnosed a concussionand a broken tooth. He ordered a CT scan to check for facialfractures too, since Molly’s face was very swollen. Molly wasreleased to her primary care physician for follow-up treatment, andher dentist repaired her broken tooth with a crown. Depending onher health insurance, Kathy’s out-of-pocket costs could run intohundreds of dollars to cover expenses like insurance co-paymentsand deductibles. MetLife Group Accident Insurance payments canbe used to help cover these unexpected costs.Covered Event3BenefitAmountAmbulance (ground) 400Emergency Care 200Physician Follow-Up ( 100 x2)Medical Testing 200 200Concussion 500Broken Tooth (repaired by crown) 300Benefits paid by MetLifeGroup Accident Insurance 1,800QUESTIONS & ANSWERSWho is eligible to enroll for this accident coverage?You are eligible to enroll yourself and your eligible family members.4 You need to enroll during your Enrollment Period andbe actively at work for your coverage to be effective.How do I pay for my accident coverage?Premiums will be conveniently paid through payroll deduction, so you don’t have to worry about writing a check or missing apayment.What happens if my employment status changes? Can I take my coverage with me?Yes, you can take your coverage with you.5 You will need to continue to pay your premiums to keep your coverage in force.Your coverage will only end if you stop paying your premium or if your employer offers you similar coverage with a differentinsurance carrier.Who do I call for assistance?Contact a MetLife Customer Service Representative at 1 800- GET-MET8 (1-800-438-6388), Monday through Friday from8:00 a.m. to 8:00 p.m., EST.