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Group Benefits Brokers

Disability insurance is underwritten by United of Omaha Life Insurance Company, Mutual of Omaha Plaza, Omaha, NE 68175, 1-800-769-7159. United of Omaha Life Insurance Company is licensed in all states except New York. Policy form number: 7000GM-U-EZ 2010 or state equivalent (In FL:7000GM-U-EZ 2001 FL 02, In NC:7000GM-U-EZ 2010 NC). In New York, disability insurance is underwritten by Mutual of Omaha Insurance Company, Mutual of Omaha Plaza. Omaha, NE 68175. Policy form number 7000GM-M-EZ 2010 NY. This policy provides disability income insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York Department of Financial Services. The expected benefit ratio for this policy is 60%. This ratio is the portion of future premiums which the company expects to return as benefits, when averaged over all people with this policy. Some exclusions, limitations and reductions may apply. Each company is responsible for its own contractual and financial obligations. For producer use only, not for use with the general public.

Long-Term Disability

Limitations

Benefit payments may be limited for the following disabilities:

• Alcohol and Drug Abuse and/or Substance Abuse 12 or 24 months
• Mental Disorder 12 or 24 months
• Self-Reported Symptoms 12 or 24 months
• Specific Conditions 12 or 24 months

Exclusions

We may not pay benefits for any Disability or loss which:

1. results from an act of declared or undeclared war or armed aggression
2. results from participation in a riot or commission of or attempt to commit a felony
3. results, whether sane or insane, from:
   1. an intentionally self-inflicted Injury or sickness; or
   2. attempted suicide
4. results from Alcohol and Drug Abuse and/or Substance Abuse except as specifically provided in the Limitations section
5. results from a Mental Disorder, except as specifically provided in the Limitations section
6. is caused by Alcohol and Drug Abuse and/or Substance Abuse, while not being actively supervised by and receiving continuing treatment from a rehabilitation center or designated institution approved for such treatment by an appropriate body in the governing jurisdiction, or if none, by us;
7. occurs while incarcerated or imprisoned for any period exceeding 31 days; or
8. is solely a result of a loss of a professional license, occupational license, or certification.

A Pre-Existing Condition Exclusion may apply. Please refer to your policy for exact provisions, limitations, reductions and exclusions.

Short-Term Disability

Exclusions

We may not pay benefits for any Disability or loss which:

1. results from an act of declared or undeclared war or armed aggression
2. results from participation in a riot or commission of or attempt to commit a felony
3. arises out of or in the course of employment with the policyholder [or for which you are entitled to benefits under any workers' compensation or occupational disease law, or receives any settlement from the workers' compensation carrier]
4. results, whether are sane or insane, from:
   1. an intentionally self-inflicted Injury or Sickness; or
   2. attempted suicide
5. occurs while incarcerated or imprisoned for any period exceeding 31 days; or
6. is solely a result of a loss of a professional license, occupational license, or certification.

AFN40102-557