U-BMC-300-A SC (07/1D)

Blanket Accident Insurance Policy

ZURICH

ZURICH AMERICAN INSURANCE COMPANY

1299 Zurich Way Schaumburg, Illinois 60196

In return for the payment of premium expressed in the Schedule, We agree to pay the benefits of this Policy to the persons insured hereunder, subject to the terms and conditions which follow. We have issued this Policy to the Policyholder. This Policy is executed as of the Policy Inception Date shown in the Schedule which is its date of issue, and from which anniversary dates are measured.

RENEWAL. This Policy will automatically renew for an additional twelve-month (12) period unless either party expresses its intent not to renew as specified in the Termination of Insurance provisions shown in Section VII.A.

This Policy is delivered in, and subject to the laws of the Contract Situs in which it is issued.

We will pay benefits described in this Policy when an Insured suffers a Covered Loss as a result of participating in a Covered Activity described in the Schedule.

BENEFITS ARE REDUCED UPON ATTAINMENT OF SPECIFIED AGES.

THIS BLANKET ACCIDENT INSURANCE POLICY PROVIDES ACCIDENT COVERAGE ONLY THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS

We and the Policyholder have agreed to all the terms of this Policy.

This is a legal contract between the Policyholder and Us.

IN WITNESS WHEREOF, this Company has executed and attested these presents and, where required by law, has caused this Policy to be countersigned by its duly Authorized Representative(s).

u !/!.

Corporate Secretary

PLEASE READ THIS POLICY CAREFULLY

NON-PARTICIPATING

TABLE OF CONTENTS

U-BMC-300-A SC (07/10)

SECTION

Section I Section II Section Ill Section IV Section V Section VI Section VII Section VIII Section IX Section X Section XI

DESCRIPTION SCHEDULE

ELIGIBILITY AND EFFECTIVE DATES OF INSURANCE

DEFINITIONS

GENERAL EXCLUSIONS GENERAL LIMITATIONS PREMIUMS

TERMINATION OF INSURANCE HOW TO FILE A CLAIM PAYMENT OF CLAIMS GENERAL POLICY CONDITIONS BENEFITS

SECTION I - SCHEDULE

(All Insurance begins and ends at 12:01 a.m. at the Policyholder's address) V. CONTRACT SITUS: South Carolina

VI. ELIGIBILITY AND CLASSIFICATION OF INSUREDS:

The following individuals are eligible to become Insureds upon the submission of completed enrollment material, if required:

If an Insured suffers a Covered Injury resulting in a Covered Loss, and he or she is covered under more than one Class, We will pay only one benefit, the largest benefit.

VII. COVERED ACTIVITY(IES):

Class I:

While participating in sponsored, scheduled and supervised intercollegiate games, practice, conditioning, and authorized team travel to and from events for the following sports:

Class II: Prospective Student Athletes while on campus during an official visit for which the athlete was invited by the Policyholder, up to two (2) Chaperones of prospective Student Athletes, while the Chaperones are on campus during an official visit by the Student Athlete. A Chaperone may be a parent, grandparent, legal guardian, spouse, sibling, aunt, or uncle whose names are reported to, and on file with the Policyholder prior to a prospective Student Athlete's visit.

VIII. AGGREGATE LIMIT OF LIABILITY: $1,000,000 per Covered Accident

IX. BENEFITS:

BENEFITS

X. REPORTING AND NOTICE ADDRESSES:

Claim Reporting:

Claims Department Bob McCloskey Insurance P.O. Box 511 Matawan, NJ 07747 800-445-3126

XI. PREMIUMS:

Premium: $25,069 per year Benefits under this Policy are Non-Contributory

SECTION II - ELIGIBILITY AND EFFECTIVE DATES OF INSURANCE INSURED'S EFFECTIVE DATE An lnsured's coverage under this Policy begins on the latest of:

1. the Policy Inception Date shown in the Schedule;

2. the date for which the first premium for the lnsured's coverage is paid; or

3. the date the person becomes a member of an eligible class of persons as described in the ELIGIBILITY AND CLASSIFICATION OF INSUREDS section on the Schedule;

A change in an lnsured's coverage under this Policy due to a change in his or her eligible class becomes effective on the later of:

1. when the change in his or her eligible class occurs; or

2. if the change requires a change in premium, the date the first changed premium is paid.

However, a change in coverage applies only with respect to Accidents that occur after the change becomes effective.

SECTION Ill - DEFINITIONS Accident or Accidental means a sudden, unexpected, specific and abrupt event that occurs by chance at an identifiable time and place during the Policy term.

Active means a member as defined by the Policyholder based on elements relating to the relationship between the organization and its members, the school and its students, the creditor and its debtors, or the vendor and its vendees, etc.

Aggregate Limit of Liability means the total Accidental Death Benefit, Accidental Dismemberment Benefit, Exposure and Disappearance Benefit and Cardiac Injury Extension, We will pay for a Covered Accident set forth in the Schedule. For purposes of the Aggregate Limit of Liability provision, a Covered Accident will arise out of a single event and include a resulting Covered Loss. If the total benefits under the Aggregate Limit of Liability is not enough to pay full benefits to each Insured, We will pay each one a reduced benefit based upon the proportion that the Aggregate Limit of Liability bears to the total benefits which would otherwise be paid.

Contributory means the Insured is required to pay all or a portion of the premium. Whether the benefits are Contributory or Non-Contributory is stated in the Schedule.

Covered Accident means an Accident that results in a Covered Loss.

Covered Activity(ies) means those activities set out in the COVERED ACTIVITIES section of the Schedule.

Covered Injury means bodily injury directly caused by Accidental means which is independent of all other causes, results from a Covered Accident, occurs while the Insured is insured under this Policy and participating in a Covered Activity, and results in a Covered Loss.

Covered Loss means a loss which meets the requisites of one or more benefits or additional benefits, results from a Covered Injury, and for which benefits are payable under this Policy.

Domestic Partner means as defined in the Policyholder's medical plan as on file and approved by Us.

To qualify as a Domestic Partner, the following requirements must be met:

1. the Insured and the Domestic Partner must have an intimate, committed relationship of mutual caring, and have agreed to be responsible for each other's welfare;

2. the Insured and the Domestic Partner must have lived together in such a relationship for a period of not less than six consecutive months at the same residence address;

3. the Insured and the Domestic Partner must both be at least 18 years of age;

4. neither the Insured nor the Domestic Partner are legally married;

5. the Insured and the Domestic Partner are not Related by blood or adoption;

6. the Insured and the Domestic Partner are each other's sole Domestic Partner and intend to remain so indefinitely; and

7. the Insured and Domestic Partner must be of the same sex, and if applicable law permitted, would be married.

The existence of the relationship between the Domestic Partner and the Insured must be evidenced by:

1. the Domestic Partner being named as the primary beneficiary in the event of the lnsured's death under the lnsured's retirement plan or 401(k) plan, if the Insured maintains such a plan;

2. at least one of the following:

a. designation of the Domestic Partner as a primary beneficiary under the lnsured's will; or

b. designation of the Domestic Partner as a primary beneficiary for the lnsured's life insurance;

3. at least one of the following:

a. joint ownership of real estate (whether by mortgage, lease or deed);

b. joint ownership of a motor vehicle; or

c. joint ownership of a bank account; and

4. a completed, active certification of Domestic Partner status form on file with the Policyholder.

To be active, the Insured will not have completed a Termination of Domestic Partner status form with respect to the Domestic Partner.

Foreign National means a person who is a citizen of a country or other jurisdiction other than the United States of America and who is not a resident of the United States of America.

Insured means any person who is eligible for coverage under this Policy as provided in the ELIGIBILITY AND CLASSIFICATION OF INSUREDS section of the Schedule, and who completes the enrollment material, if required.

Limb means an arm or a leg.

Non-Contributory means the Insured is not required to contribute toward the premium. Whether the benefits are Contributory or Non-Contributory is stated in the Schedule.

Physician means a person who is:

1. a doctor of medicine, osteopathy, psychology or other legally qualified practitioner of a healing art that We recognize or are required by law to recognize;

2. licensed to practice in the jurisdiction where care is being given;

3. practicing within the scope of that license; and

4. not related to the Insured by blood or marriage.

Plan means the coverages and/or benefits selected in the Schedule.

Policy means this Blanket Accident Insurance Policy. Policyholder means the entity named as such in the Schedule. Spouse means the lnsured's legally married Spouse.

We, Us, and Our means Zurich American Insurance Company or Our authorized representative.

SECTION IV - GENERAL EXCLUSIONS

A loss will not be a Covered Loss if it is caused by, contributed to, or results from:

1. suicide or any attempt at suicide, sane or insane, or intentionally self-inflicted injury or any attempt at intentionally self-inflicted injury.

2. war or any act of war, whether declared or undeclared.

3. involvement in any type of active military service.

4. illness or disease, regardless of how contracted; medical or surgical treatment of illness or disease; or complications following the surgical treatment of illness or disease; except for Accidental ingestion of contaminated foods.

5. participation in the commission or attempted commission of any felony.

6. parasailing, bungee jumping, heli-skiing, scuba diving or any other extra-hazardous activity.

7. being intoxicated while operating a motor vehicle.

a. An Insured will be conclusively presumed to be intoxicated if the level of alcohol in his or her blood exceeds the amount at which a person is presumed, under the law of the locale in which the Accident occurred, to be intoxicated, if operating a motor vehicle.

b. An autopsy report from a licensed medical examiner, law enforcement officer reports, or similar items will be considered proof of the lnsured's intoxication.

8. being under the influence of any narcotic unless taken on the advice of a Physician.

9. travel or flight in any aircraft except as a fare-paying passenger on a regularly scheduled charter or commercial flight.

10. any condition for which the Insured is entitled to benefits under any Workers' Compensation Act, No Fault Auto Coverage or similar law.

11. the Insured riding in or driving any type of motor vehicle as part of a speed contest or scheduled race, including testing such vehicle on a track, speedway or proving ground.

SECTION V- GENERAL LIMITATIONS

Benefits are payable only for Covered Losses incurred as a result of participation in Covered Activities.

LIMITATION ON MULTIPLE COVERED LOSSES: If an Insured suffers more than one Covered Loss as a result of the same Accident, We will pay only one benefit, the largest benefit.

LIMITATION ON MULTIPLE COVERED ACTIVITIES: If an Insured suffers a Covered Loss while participating in more than one Covered Activity, We will pay only one benefit, the largest benefit unless there is a specific written exception in this Policy.

LIMITATION ON MULTIPLE BENEFITS: If an Insured can recover benefits under more than one of the Benefits stated in the Schedule, as a result of the same Accident, We will pay only one benefit, the largest benefit.

LIMITATION ON MULTIPLE COVERED POLICIES: If an Insured can recover benefits under more than one accident policy written by Zurich American Insurance Company, We will pay under only one policy, the policy which offers the Insured the largest benefit.

SECTION VI - PREMIUMS

A. PREMIUMS: Premiums are due and payable to Us at the rates and in the manner described in the Schedule. All rates are expressed and all premiums are payable in United States currency. If, at any time, it is determined that additional premium or a premium credit is due, the additional premium must be paid or the premium credit applied at the next premium due date. Except in the case of fraud, premium adjustments will be made only for the current Policy Period and the prior Policy Period.

B. GRACE PERIOD: Premiums are due for this Policy on or before the premium due date or renewal date, whichever applies. If a renewal premium is not paid when it is due, there is a thirty-one (31) day Grace Period (the "Grace Period") to pay. During the Grace Period, the Policy will stay in force. There will not be a Grace Period if We have given notice, at least thirty (30) days in advance, that We are going to terminate this Policy.

C. CHANGE IN PREMIUM: We may change the premium as a condition of any renewal of this Policy by giving at least thirty-one (31) days written notice to the Policyholder. We may also change premium at any time when any change, agreed upon in writing, between the Policyholder and Us is made that affects coverage or if it is discovered that there was a material misrepresentation in the information relied upon in establishing the premiums.

SECTION VII -TERMINATION OF INSURANCE

A. POLICY RENEWAL AND TERMINATION:

RENEWAL: This Policy will automatically renew for an additional twelve-month (12) period unless either party expresses its intent to terminate as specified herein.

TERMINATION BY POLICYHOLDER: The Policyholder may terminate this Policy by delivering to Us a written notice to end this Policy at least thirty (30) days in advance of such termination. We will calculate and return the unearned premium, if any, using a standard short rate table. The Policyholder will send Us any additional amounts owed, if any, between the Policy's paid to date and the official date of termination.

TERMINATION BY US: We may terminate this Policy by giving the Policyholder at least thirty (30) days' notice of Our intent to terminate. Such notice will state the exact date the Policy will terminate. We will mail a notice of such termination to the Policyholder's last address shown in Our records.

We may also, at any time, end this Policy for non-payment of premium on any premium due date if the payment is not received prior to the end of the Grace Period. We will mail a notice of such termination to the Policyholder's last address shown in Our records.

Termination will be without prejudice to any claim which commenced prior to the effective date of termination.

SECTION VIII - HOW TO FILE A CLAIM

A. NOTICE: The Insured or the beneficiary, or someone on their behalf, must give Us written notice of the Covered Loss within ninety (90) days of such Covered Loss, or as soon thereafter as reasonably possible. The notice must name the Insured, and the Policy Number. To request a claim form, the Insured or the beneficiary, or someone on their behalf may contact Bob McCloskey Insurance at 800-445-3126. The notice must be sent to the address shown on the Schedule, or any of Our agents. Notice to Our agents is considered notice to Us.

B. CLAIM FORMS: We will send the claimant Proof of Covered Loss forms within fifteen (15) days after We receive notice. If the claimant does not receive the Proof of Covered Loss form in fifteen (15) days after submitting notice, he or she can send Us a detailed written report of the claim and the extent of the Covered Loss. We will accept this report as a Proof of Covered Loss if sent within the time fixed below for filing a Proof of Covered Loss.

C. PROOF OF COVERED LOSS: Written Proof of Covered Loss, acceptable to Us, must be sent within ninety (90) days of the Covered Loss. Failure to furnish Proof of Covered Loss acceptable to Us within such time will neither invalidate nor reduce any claim if it was not reasonably possible to furnish the Proof of Covered Loss, and the proof was provided as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one (1) year from the time proof is otherwise required.

SECTION IX- PAYMENT OF CLAIMS

A. TIME OF PAYMENT: We will pay claims for all Covered Losses, other than Covered Losses for which this Policy provides any periodic payment, immediately upon receipt of written proof of loss that is acceptable to Us. Unless an optional periodic payment is stated or chosen, any Covered Loss to be paid in periodic payments will be paid at the end of each four-week period. The unpaid balance, which remains when Our liability ends, will then be paid when We receive the Proof of Covered Loss that is acceptable to Us.

B. WHO WE WILL PAY:

1. LOSS OF LIFE OF AN INSURED: Covered Losses resulting from the lnsured's death are paid to the named beneficiary at the time of death. If there is no beneficiary named or the named beneficiary predeceases or dies at the same time as the Insured, We will pay the benefit to the lnsured's estate.

2. ALL OTHER CLAIMS: Benefits are to be paid to the Insured.

3. If a Foreign National is entitled to benefits for a Covered Loss and We are unable to make payment directly to him or her because of legal restrictions in the country or jurisdiction where such Foreign National is located, We will either: (1) pay the benefits to a bank account owned by the Foreign National in the United States of America; or (2) if no such bank account is established or maintained, We will pay the benefits to the Policyholder on behalf of the Foreign National. It will then be the responsibility of the Policyholder to remit the benefit to such Foreign National. Payment of the benefit to the Policyholder will release Us from any further liability to the Foreign National. If the Policyholder does not remit the payment to the Foreign National, the Policyholder will indemnify Us and hold Us harmless against any and all liability incurred by Us including, but not limited to, interest, penalties, and attorneys' fees in connection with, arising or resulting from such failure to remit payment. The Policyholder will not be considered the beneficiary under the Policy if payment is made to the Policyholder in accordance with this provision.

4. Any payment We make will fully discharge Us to the extent of the payment.

SECTION X - GENERAL POLICY CONDITIONS

A. BENEFICIARIES: The Insured has the sole right to name a beneficiary. The beneficiary has no interest in the Policy other than to receive certain payments. Unless an irrevocable beneficiary is named, The Insured may change the beneficiary at any time unless he or she has assigned the interest in the Policy. In such case, the person to whom he or she has assigned the interest in this Policy may have the right to change the beneficiary. Consent to a change by a prior beneficiary is not needed. Any beneficiary designation must be in writing on a form acceptable to Us.

B. CHANGE OR WAIVER: A change or waiver of any terms or conditions of this Policy must be issued by Us in writing and signed by one of Our executive officers. No agent has authority to change or waive Policy terms or conditions. A failure to exercise any of Our rights under this Policy will not be deemed as a waiver of such rights in the same or future situations.

C. CLERICAL ERROR: A clerical error or omission will not increase or continue an lnsured's coverage, which otherwise would not be in force. If an Insured applies for insurance for which he or she is not eligible, We will only be liable for any premiums paid to Us.

D. CONFORMITY WITH STATUTE: Terms of this Policy that conflict with the laws of the state where it is delivered are amended to conform to such laws.

E. ENTIRE CONTRACT: This Policy, the Policyholder application, Insured enrollment materials, Benefit Riders, and any other attachments represent the entire insurance contract between the Policyholder and Us.

F. INSURED CERTIFICATES: Where required by state law, We will make available certificates containing a summary of terms that affect benefits.

G. SUIT AGAINST US: No action on this Policy may be brought until sixty (60) days after written Proof of Covered Loss has been sent to Us. Any action must commence within three (3) years, (five (5) years in Kansas and Tennessee; and six (6) years in South Carolina and Wisconsin) of the date the written Proof of Covered Loss was required to be submitted. If the law of the state where the Insured lives makes such limit void, then the action must begin within the shortest time period permitted by law.

H. PHYSICAL EXAMINATION AND AUTOPSY: We have the right to examine an Insured when and as often as We may reasonably request while the claim is pending. Such examination will be at Our expense. We can have an autopsy performed unless forbidden by law. The autopsy must be performed in South Carolina.

I. POLICYHOLDER RECORDS: The Policyholder will keep a record of the coverage, premium and other pertinent administrative information for each Insured, which, if acceptable to Us will be deemed to be a part of the Policy. We may examine these records at reasonable times while the Policy is in force and for six years after the termination of the Policy. The Policyholder will report to Us within a reasonable time all changes in information regarding an Insured. The Policyholder will indemnify Us for any benefits or other payments that are caused in whole or in part by the Policyholder's negligence or error in performing the record keeping function.

J. CHOICE OF SERVICE PROVIDER: The Insured has the sole right to choose his or her duly licensed Physician and hospital.

K. TIME LIMIT ON CERTAIN DEFENSES: In the absence of fraud, statements made by the Policyholder or an Insured are deemed representations and not warranties. No such statement will cause Us to deny or reduce the benefits due under this Policy or be used as a defense of a claim, unless it is contained in a signed written application. After two years from the date coverage starts no such statement (except age) will cause this Policy to be contested.

L. MISSTATEMENT OF AGE. If the age of the Insured has been misstated, We will adjust the benefits under this Policy to those that would be applicable at the correct age.

SECTION XI - BENEFITS

ACCIDENTAL DEATH BENEFIT

If an Insured suffers a loss of life as a result of a Covered Injury, We will pay the applicable amount shown in the Schedule. The death must occur within 365 days of the Covered Injury.

ACCIDENTAL DISMEMBERMENT BENEFIT

If a Covered Injury to an Insured results in any of the following Covered Losses, We will pay the percentage shown below. The Covered Loss must occur within 365 days of the Covered Accident.

The benefit amount is based on the maximum amount shown in the Schedule for the person suffering the Covered Loss.

For purposes of this Benefit, DEFINITIONS is amended to include the following:

Covered Loss means:

1. For a foot or hand, actual severance through or above the ankle or wrist joint;

2. For thumb and index finger, complete severance through or above the metacarpophalangeal joint of both digits;

3. Total and permanent loss of sight;

4. Total and permanent loss of speech; or

5. Total and permanent loss of hearing.

Plegia means a permanent, complete and irreversible loss of voluntary movement that affects motor function of one (1) or more Limbs. Proof of total Plegia may be required by Us on a periodic basis. Benefits are not payable for paralysis caused by a stroke.

This benefit is payable based on the following table.

Hemiplegia (total paralysis of upper and lower Limbs on one side of the body) 50% Uniplegia (total paralysis of one Limb) 25% Plegia must continue for 12 consecutive months and be determined by Our competent medical authority.

EXPOSURE AND DISAPPEARANCE BENEFIT

If an Insured is exposed to weather because of an Accident and this results in a Covered Loss, We will pay the applicable amount shown in the Schedule subject to all Policy terms.

If the conveyance in which an Insured is riding disappears, is wrecked, or sinks, and the Insured is not found within 365 days of the event, We will presume that the person lost his or her life as a result of injury. If travel in such conveyance was covered under the terms of this Policy, We will pay the applicable amount shown in the Schedule, subject to all Policy terms. We have the right to recover the benefit if We find that the Insured survived the event.

Accident Medical Expense Benefit

ZURICH

Zurich American Insurance Company 1299 Zurich Way Schaumburg, Illinois 60196

U-BMC-380-B SC (01/20)

THIS RIDER CHANGES THE POLICY/CERTIFICATE. PLEASE READ IT CAREFULLY.

This rider modifies insurance provided under the Blanket Accident Insurance Policy.

It is hereby understood and agreed that the following changes are made and incorporated into the Policy:

SCHEDULE

Benefit

Maximum Benefit per Insured per Covered Accident

Deductible per Insured per Covered Accident Co-Insurance:

Our share of Usual and Customary Expenses per Insured per Covered Accident

per Insured per Covered Accident

We will pay Our share of the Usual and Customary Expenses for Medically Necessary Covered Medical Service(s) incurred by the Insured resulting from a Covered Accident while participating in a Covered Activity, up to the Maximum Benefit shown on the Schedule. Coverage is provided in excess of the Deductible and subject to the co-insurance shown in the above Schedule provided that:

1. the first treatment or service occurs within one hundred eighty (180) of the Covered Injury; and

2. the medical expenses are incurred within One hundred four (104) of the Covered Injury.

For this benefit only, the following definitions apply:

Covered Medical Service(s) means any of the following services when Medically Necessary for a Covered Injury:

1. Hospital room and board expenses: the daily room rate when an Insured is Hospital Confined and general nursing care is provided and charged for by the Hospital. In computing the expenses payable under this benefit, the date of admission will be counted but not the date of discharge.

2. Ancillary or miscellaneous inpatient Hospital expenses: services and supplies including operating room, laboratory tests, anesthesia and medicines (excluding take home drugs) when Hospital Confined.

3. Medical Emergency care (room and supplies) expenses incurred within twenty-four (24) hours of an Accident and including the emergency room or attending Physician's charges, X-rays, laboratory procedures, use of the emergency room and supplies.

4. Outpatient surgical room and supply expenses for use of the surgical facility (including ambulatory surgical facilities).

5. Diagnostic X-rays, laboratory procedures and tests.

6. Treatment for heat stroke and heat exhaustion.

7. Physician non-surgical treatment/examination expenses (excluding medicines) including the Physician's initial visit, each necessary follow-up visit and consultation visits when referred by the attending physician.

8. Physician's surgical expenses that require singular or multiple surgical procedures during the same operative session through the same or different incision, We will pay only one benefit, the largest of the procedures performed. The Physician's surgical procedure(s) must be the result of a Covered Injury.

9. Anesthesiologist expenses for pre-operative screening and administration of anesthesia during a Physician's surgical procedure whether on an inpatient or outpatient basis. The Physician's surgical procedure(s) must be the result of a Covered Injury.

10. Assistant Physician expenses.

11. The services of a Registered Nurse (the nurse cannot be a member of the lnsured's immediate family).

12. Physiotherapy expenses on an inpatient or outpatient basis. Expenses include treatment and office visits connected with such treatment when prescribed by a Physician, including diathermy, ultrasonic, whirlpool, or heat treatments, adjustments, manipulation, massage or any form of physical therapy and/or occupational therapy.

13. Radiological procedures including: cardiac imaging and nuclear medicine and molecular imaging related to a Covered Injury and prescribed by a Physician.

14. Diagnostic imaging expenses including Magnetic Resonance Imaging (MRI) and Computed Axial Tomography (CAT) Scan related to a Covered Injury and prescribed by a Physician.

15. Ambulance expenses for transportation from the emergency site to the Hospital (excluding air ambulance).

16. Rehabilitative limb braces, wheelchairs and other medical equipment or appliances prescribed by a Physician and related to the Covered Injury. It must be durable medical equipment that:

a. is primarily and customarily used to serve a medical purpose;

b. can withstand repeated use; and

c. generally is not useful to a person in the absence of injury.

No benefits will be paid for rental charges in excess of the purchase price.

We will not cover computers, motor vehicles or modifications to a motor vehicle, ramps and installation costs.

17. Eyeglasses, contact lenses or hearing aids damaged or destroyed as a result of a Covered Injury and prescribed by a Physician.

18. Prescription drug expenses for Covered Injuries, prescribed by a Physician and administered on an outpatient basis.

19. Expenses for blood, blood transfusions and oxygen (including delivery of tanks and equipment and its administration).

20. Dental treatment for teeth, gums or structures directly supporting the teeth performed as a result of a Covered Injury.

21. Treatment resulting from complications of pregnancy due to a Covered Injury.

Custodial Services means medical and non-medical care, including, but not limited to, services which are:

1. related to watching or protecting the Insured if as a result of a Covered Injury they are deemed by a Physician to require daily preventative care for a period of one (1) to ninety (90) days;

2. related to performing, or assisting the Insured in performing any activities of daily living such as: walking, grooming, bathing, dressing, getting in or out of bed, toileting, eating, preparing foods, or taking medications that can be either self-administered or require medical assistance;

3. performed by trained or skilled medical personnel; and

4. which, in the absence of inpatient hospital care, would otherwise be required.

Deductible means a dollar amount of the Usual and Customary Expenses which must be incurred as an out-of-pocket expense, by an Insured for each Covered Injury, before benefits are payable under this Policy. The Deductible amount is shown on the Schedule.

Dependent means an lnsured's Spouse/Domestic Partner and Dependent Child{ren), as defined in this section.

Dependent Child{ren) means those unmarried Child{ren) of the Insured, and those unmarried Child{ren) of his or her Spouse/Domestic Partner who rely on the Insured for more than 50% of their support, and are either: 1) less than 19 (nineteen) years of age; 2) less than 26 (twenty-six) years of age and enrolled on a full-time basis in a college, university, or trade school, or who satisfy neither 1) nor 2), but who prior to his or her termination of coverage became incapable of self-sustaining employment by reason of mental or physical handicap.

U-BMC-380-B SC (01/20)

Emergency means a condition caused by a Covered Injury which:

1. presents a severe or acute symptom requiring immediate care and the failure to obtain such care could reasonably result in serious deterioration of the lnsured's condition or place his or her life in jeopardy; and

2. the severe or acute symptom occurs suddenly and unexpectedly.

Hospital means an institution which:

1. operates pursuant to applicable local laws and regulations governing such facilities;

2. primarily and continuously provides medical care and treatment to sick and injured persons on an inpatient basis;

3. operates facilities for medical and surgical diagnosis and treatment by or under the supervision of Physicians;

and

4. provides 24-hour nursing service by or under the supervision of Registered Nurses (R.N.) or graduated nurses.

Hospital does not mean any institution or part thereof which is used primarily as:

1. a nursing home, convalescent home, or skilled nursing facility;

2. a place of rest, custodial care, or for the aged;

3. a clinic; or

4. a place for the treatment of mental illness, alcoholism or substance abuse.

However, a place for the treatment of mental illness, alcoholism or substance abuse will be regarded as a Hospital if it is:

1. part of the institution that meets the requirements in subparagraphs 1 - 4 above; and

2. listed in the American Hospital Association Guide as a general Hospital.

Hospital Confined means admission to a Hospital as an inpatient for at least 24 consecutive hours by a Physician. A Hospital stay that does not result in charges to the Insured is not a hospital confinement under this rider unless there is no charge because the Hospital is a United States government facility.

In Force Policy means any multiple group, group-type, family or individual health care policy covering the Insured and in effect at the time of the Covered Injury, or subsequently thereafter, other than the Policy to which this rider is attached.

Medically Necessary means that the medical service or treatment:

1. is for the diagnosis, treatment or care of the Covered Injury for which it is prescribed or performed;

2. meets standards of medical practice; and

3. is ordered by a Physician.

Principal Residence means the legal domicile of the Insured. If the Insured has dual citizenship, his or her country of citizenship is the country of the passport he or she used to enter the location in which he or she is traveling.

Usual and Customary Expense(s) means an amount(s) that: (1) does not exceed the usual cost for similar treatment, services or supplies in the locality in which it is incurred; or for a Hospital room and board charge other than for stay in an intensive care unit, does not exceed the Hospital's most common charge for semi-private room and board or the fee set by the workers' compensation insurance fee schedule, if applicable; and (2) does not include charges that would not have been made if no insurance existed and (3) does not exceed the cost of a generic drug, if available.

EXCLUSIONS:

In addition to the General Exclusions stated in the Policy, We will not cover expenses under this additional benefit for:

1. Cosmetic, plastic or restorative surgery unless Medically Necessary for the treatment of the Covered Injury.

2. Any medical expenses related to pregnancy unless Medically Necessary for the treatment of the Covered Injury.

3. Covered Injury for which the Insured is entitled to benefits under Workers Compensation Benefits, Employer Liability Law, or any statutorily mandated coverage.

4. Personal comfort or convenience items, such as but not limited to Hospital telephone charges, television rental, guest meals, or internet charges.

5. Treatment by any immediate family member or member of the lnsured's household.

U-BMC-380-B SC (01/20)

6. Expenses incurred for dental care, treatment, repair or replacement of sound natural teeth unless Medically Necessary for the treatment of the Covered Injury.

7. Expenses incurred for eye examinations, contact lenses or the fitting, repair or replacement of these items unless Medically Necessary for the treatment of the Covered Injury.

8. Routine physical examinations and related medical services, elective treatment or surgery or experimental or investigative treatments or procedures.

9. Expenses incurred for psychological or psychiatric counseling of any kind or any expense for treatment of mental or nervous diseases or disorders.

10. Expenses which the Insured is not legally obligated to pay.

11. Expenses for Custodial Services or services provided by a private duty nurse unless such expenses are incurred as a result of a Covered Injury, as prescribed by a Physician.

12. Expenses related to the repair or replacement of existing artificial limbs, eyes, or other prosthetic appliances, or rental of existing medical equipment unless for the purpose of modifying the item because the Covered Injury has caused further impairment of the underlying bodily condition.

EXCESS INTEGRATED

The benefit amount for this benefit is payable in excess of any In Force Policy and its applicable deductible. In the event and only in the event of the reduction or exhaustion of the limit of insurance of the In Force Policy solely as the result of actual payment of benefits covered thereunder, this Policy shall pay excess of the reduced limit of insurance of the In Force Policy and its applicable deductible. This Policy shall only pay pursuant to the terms and conditions of this Policy and no other policy.

We will pay Our share of the Usual and Customary amount, reduced by the payment of any other insurance plan. This Policy will recognize payment by any other insurance plan as reducing or satisfying the deductible amount of this Policy. In no event will We pay more than the maximum amount stated in this rider.

If no In Force Policy exists, this Policy will pay benefits on a primary basis subject to the deductible and coinsurance amounts stated on the Schedule and a fifty percent (50%) reduction of the benefit will be made to the amount otherwise payable.

EXTENSION OF BENEFITS

If a Covered Accident commences while this rider is in force as to an Insured, benefits otherwise payable under this rider for the Covered Accident causing the Total Disability will also be paid for any Usual and Customary expenses incurred after the termination of insurance for an Insured if, from the date of such termination to the date such expenses are incurred, the Insured is Totally Disabled by reason of such Covered Accident. Such benefits shall be payable only during the continuance of such disability for a period of ninety (90) days.

SUBROGATION

We have the right to recover from any third party all payments including future payments, which We have made to the Insured or on behalf of the lnsured's Spouse or Domestic Partner, child, heirs, guardians or executors or will be obligated to pay in the future to the Insured, from any Third Party. If the Insured recovers from any third party, We will be reimbursed first from such recovery to the extent of Our payments to or on behalf of the Insured. The Insured agrees to assist Us in preserving its rights against any third party, including but not limited to, signing subrogation forms supplied by Us. Attorney's fees and costs will be paid by Us from the amounts recovered.

Except for the above, this rider does not vary, alter, waive, or extend any of the terms of the Policy to which it is attached.

Effective Date: August 1, 2022 Attached to and forming a part of Policy/Certificate No. MCB 4850979

Cardiac Injury Extension

ZURICH

Zurich American Insurance Company 1299 Zurich Way Schaumburg, Illinois 60196

U-BMC-393-A SC (10/20)

THIS RIDER CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This rider modifies insurance provided under the Blanket Accident Insurance Policy/Certificate.

It is hereby understood and agreed that the following changes are made and incorporated into the Policy/Certificate:

The Accidental Death, Accidental Dismemberment and Accident Medical Expense benefits are extended to apply to Cardiac Injury.

For the purposes of this benefit only, the following definitions apply:

Cardiac Injury means a sudden Heart or Circulatory Malfunction if the first symptoms of such malfunction are medically diagnosed:

1. while the Insured is covered under the Policy;

2. while the Insured is participating in a Covered Activity; and

3. within 72 hours of the Covered Activity.

The Insured must be under age 90 and must not have been medically diagnosed that he or she has, nor received any Medical Care for:

1. a Heart or Circulatory Malfunction; or

2. hypertension, angina, or other heart or circulatory condition. within 5 years prior to the date of the Covered Activity.

Heart or Circulatory Malfunction means a sudden and serious malfunction of the heart or circulatory system as a result of coronary thrombosis, cerebral vascular accident, myocardial infarction, and cardiac arrest, diagnosed by a Physician. Heart or Circulatory Malfunction does not refer to conditions such as hypertension and angina.

Medical Care means necessary:

1. medical or surgical treatment, services and supplies; and

2. hospital, nursing and ambulance services. Each item of Medical Care must be:

1. prescribed by a Physician; and

2. for the sole purpose of treating the Injury.

This rider is subject to the limitations in Section V General Limitations of the Policy/Certificate.

Except for the above, this rider does not vary, alter, waive, or extend any of the terms of the Policy to which it is attached.

Effective Date: August 1. 2022 Attached to and forming a part of Policy No. MCB 4850979

IN WITNESS WHEREOF, this Company has executed and attested these presents and, where required by law, has caused the Policy to be countersigned by its duly Authorized Representative(s).

President Corporate Secretary

Aggregate Deductible Endorsement

ZURICH

Zurich American Insurance Company 1299 Zurich Way Schaumburg, Illinois 60196

U-BMC-383-A CW (01/20)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the Blanket Accident Insurance Policy.

It is hereby understood and agreed that the following changes are made and incorporated into the Policy:

SCHEDULE

Aggregate Deductible (applies to Accident Medical Expense Benefit only): Aggregate Deductible: $195,000

AGGREGATE DEDUCTIBLE LIMITATION

The Aggregate Deductible is the amount that must be incurred and paid by the Policyholder before Accident Medical Expense Benefits become payable under this Policy. The amount of Covered Medical Services per Insured per Covered Accident that can be applied towards the Aggregate Deductible is the Individual Limit. The Aggregate Deductible amount is shown in the Schedule of this Endorsement.

Retention Amount The Covered Medical Services applied to the Aggregate Deductible amounts are the Policyholder's Retention Amount. The Retention Amount is self-insured by the Policyholder. The Retention Amount is the amount of claims that the Policyholder must incur and pay after the date of loss.

Any portion of a claim incurred prior to the termination of the Policy that is applicable to the Retention Amount will not be affected by the termination; that portion of the claim will remain the responsibility of the Policyholder.

The Policyholder's bankruptcy, insolvency, or inability to pay the Retention Amount will not increase Our obligations under the Policy.

Legal Suit If a claim or suit is brought against Us under the Policy, We will defend Ourselves and the Policyholder will indemnify Us up to the amount for which the Policyholder is liable under the Policy as if said action were a claim or suit brought against the Policyholder.

Effective Date: August 1. 2022 Attached to and forming a part of Policy No. MCB 4850979

SANCTIONS EXCLUSION ENDORSEMENT

ZURICH

U-GU-1192-A CW (03/15)

Page I of I

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY

The following exclusion is added to the policy to which it is attached and supersedes any existing sanctions language in the policy, whether included in an Exclusion Section or otherwise:

SANCTIONS EXCLUSION

Notwithstanding any other terms under this policy, we shall not provide coverage nor will we make any payments or provide any service or benefit to any insured, beneficiary, or third party who may have any rights under this policy to the extent that such coverage, payment, service, benefit, or any business or activity of the insured would violate any applicable trade or economic sanctions law or regulation.

The term policy may be comprised of common policy terms and conditions, the declarations, notices, schedule, coverage parts, insuring agreement, application, enrollment form, and endorsements or riders, if any, for each coverage provided. Policy may also be referred to as contract or agreement.

We may be referred to as insurer, underwriter, we, us, and our, or as otherwise defined in the policy, and shall mean the company providing the coverage.

Insured may be referred to as policyholder, named insured, covered person, additional insured or claimant, or as otherwise defined in the policy, and shall mean the party, person or entity having defined rights under the policy.

These definitions may be found in various parts of the policy and any applicable riders or endorsements.

ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED

ZURICH

Privacy Notice We Take Important Steps to Protect the Nonpublic Personal Information We Collect About You

Dear Customer: rev. January 2020

We care about your privacy. That is why we believe in your right to know what nonpublic personal information ("NPI") we collect about you and what we do with that information. This Privacy Notice describes the NPI we collect about you and how we share and protect that information.

we collect?

· Information about you we receive on applications or other forms, such as your name, address, telephone number, date of birth, your social security number, driver's license number, employment information, information about your income, assets and net worth, and medical information;

· Information about your transactions with the Company and its affiliates;

· Information about your insurance coverage, premiums, claims history, and payment history;

· Data from insurance support organizations, government agencies, insurance information sharing bureaus;

· Property information and similar data about you or your property, such as property appraisal reports; and

· Information we receive from a consumer reporting agency or insurance information sharing bureau, such as a credit or fraud report.

When your relationship with us ends, we may continue to share information about you as described in this Privacy Notice.

Why are you Financial institutions, which include the Company, choose how they share your NPI. Federal and receiving this state law gives consumers the right to limit some but not all sharing of that information. Federal law Notice? also requires us to tell you how we collect, share and safeguard your NPI. You are receiving this Privacy Notice because our records show either that you are a customer who is obtaining or has obtained insurance coverage or non-insurance products or services.

These affiliates and nonaffiliated third parties include:

· Financial service providers, such as banks and other insurance companies;

· Non-financial companies, such as medical providers and nonaffiliated service providers that perform marketing services on our behalf; and

· Others, such as consumer reporting agencies and insurance information sharing bureaus.

U-GU-1107-D CW (01/20)

©2020 Zurich American Insurance Company

In the section below, we list the reasons we can share your NPI, whether we actually share your NPI, and whether you can opt out of this sharing (or if you are a resident of Vermont, whether you have the right to opt in to allowing this sharing).

For our affiliates' everyday business purposes - transaction and experience information

Yes

No